Does lymph node positivity ratio correlate with survival following curative resection for gallbladder carcinoma: a prospective study

Abstract

Background: In gallbladder carcinoma, lymph node metastasis is an important predictor of survival. This study assessed the survival with respect to ratio of metastatic nodes to total number of nodes harvested (lymph node ratio, LNR). Methods: Between Jan 2012 to May 2017, 128 patients underwent curative intent resection for gallbladder cancer. In order to achieve a minimum of 3 years follow up, data of 44 patients (Jan 2012 to May 2014) were analysed. LN location was divided into N1 (hepatoduodenal, including 13a (PSPD) and common hepatic artery) and N2 (celiac, SMA and aorto-caval). As the median LNR was 10%, the LNR was divided into three groups: 0%, 10% and > 10%. Survival data was calculated using Kaplan-Meier and Cox regression model used to analyse between groups. Results: 39 patients were available for the study. In total, 633 (mean 16) nodes were retrieved. Among this, 31 nodes were positive in 14 patients. LNR was 10% in 4 (28%) and > 10% in 10 (71%) patients. The median follow-up was 50 months (IQR 43-58). 14 patients died during follow-up. The median disease-free (DFS) and overall survival (OS) were 43.7months (IQR 14-52) and 46 months (IQR 20-54) respectively. The median DFS of patients with LNR >10 % is 14.6 months and LNR 10% is 21.4months; patients with negative nodal disease did not reach median survival (p=0.014). The OS of patients with LNR 10 was 14 months (95% CI: 4.7-24.5). Conclusion: LNR>10 % was associated with adverse prognosis in gallbladder cancer.