High rate of positive lymph nodes in T1a gallbladder cancer does not translate to decreased survival: a population-based, propensity score adjusted analysis

Köhn, Nastassja; Maubach, Johannes; Warschkow, René; Tsai, Catherine; Nussbaum, Daniel P.; Candinas, Daniel; Gloor, Beat; Schmied, Bruno M.; Blazer, Dan G.; Worni, Mathias

doi:10.1016/j.hpb.2018.05.007

Cited by 13 publications

(6 citation statements)

References 46 publications

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“…Currently, the NCCN recommends radical cholecystectomy with en bloc hepatic resection and regional lymph node dissection (LND) for tumors staged as T1b or higher; in contrast, T1a tumors can be treated with simple cholecystectomy . Indeed, a recent report by Kohn et al reported that lymphadenectomy for T1a tumors was not associated with a survival benefit, whereas LND improved OS among patients with T1b and T2 disease . Interestingly, Kasumova et al noted that 89% of patients with T2 or T3 GBC included in the NCDB underwent a simple cholecystectomy rather than radical cholecystectomy, which was also consistent with our findings.…”

Section: Discussionsupporting

confidence: 91%

“…The NCDB captures approximately 70% of all newly diagnosed cancers from more than 1500 Commission on Cancer‐accredited centers in the United States annually . Patients with a histological diagnosis of gallbladder cancer were identified in the NCDB between January 1, 2004, and December 31, 2015. International Classification of Diseases for Oncology (ICD‐O‐3) topography codes C23.9 (gallbladder) and histology code 8140, 8141, 8144, 8201, 8210, 8211, 8255, 8260‐63, 8310, and 8323 were applied in the NCDB Participant User File to identify adenocarcinoma of the gallbladder as previously described . Patients were excluded if they did not undergo surgery for GBC, did not have data on nodal status and the number of LN examined and their survival status was unknown.…”

Section: Methodsmentioning

confidence: 99%

“…File to identify adenocarcinoma of the gallbladder as previously described. 15 Patients were excluded if they did not undergo surgery for GBC, did not have data on nodal status and the number of LN examined and their survival status was unknown.…”

mentioning

confidence: 99%

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The optimal number of lymph nodes to evaluate among patients undergoing surgery for gallbladder cancer: Correlating the number of nodes removed with survival in 6531 patients

Tsilimigras

Hyer

Paredes

et al. 2019

Journal of Surgical Oncology

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Background The aim of the current study was to identify the minimum number and the optimal range of lymph nodes (LNs) to be examined among patients with gallbladder cancer (GBC). Methods Between January 1, 2004, and December 31, 2015, patients with a diagnosis of GBC were identified in the National Cancer Database. A machine‐based learning approach was used to identify the minimum number and range of LNs to evaluate relative to long‐term outcomes. Results Among 6531 patients with GBC, median number of LNs evaluated was 2 (IQR:1‐5); only 21.1% (n = 1376) of patients had 6 or more LNs evaluated. The median number of metastatic LNs was 0 (IQR: 0‐1). On multivariable analysis, evaluation of < 4 LNs was associated with a higher hazard of death (referent 4‐7 LNs: < 4 LNs, HR = 1.27, 95% CI, 1.16‐1.40; P < 0.001), whereas, patients who had 4 to 7 LNs and > 7 LNs evaluated had comparable long‐term mortality risk (HR = 1.10, 95%CI, 0.98‐1.24; P = 0.11). There was no difference in the proportion of patients who had at least one metastatic LN identified per T category based on total number of nodes resected (all P > 0.05). Conclusion The overwhelming majority of patients did not have the American Joint Committee on Cancer (AJCC) recommended 6 total LN count . A machine‐based learning approach identified evaluation of 4 to 7 LNs as the LN number associated with optimal staging and survival. While obtaining 6 LNs may be challenging, evaluation of at least 4 LNs may be a more appropriate threshold as this cut‐off value was associated with optimal patient outcomes and staging.

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Section: Discussionsupporting

confidence: 91%

Section: Methodsmentioning

confidence: 99%

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The optimal number of lymph nodes to evaluate among patients undergoing surgery for gallbladder cancer: Correlating the number of nodes removed with survival in 6531 patients

Tsilimigras

Hyer

Paredes

et al. 2019

Journal of Surgical Oncology

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“…Gallbladder cancer in general has a poor prognosis. Provided that the patient is medically fit for surgery, previous data support re‐resection of T1b, T2 and T3 incidental cancers to improve survival. Re‐resection includes partial hepatectomy of segments IVb and V, either as wedge resection or bisegmentectomy, and lymph node dissection.…”

Section: Introductionmentioning

confidence: 99%

Management of incidental gallbladder cancer in a national cohort

Lundgren

Muszynska

Ros

et al. 2019

British Journal of Surgery

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Background Incidental gallbladder cancer is a rare event, and its prognosis is largely affected by the tumour stage and treatment. The aim of this study was to analyse the management, treatment and survival of patients with incidental gallbladder cancer in a national cohort over a decade. Methods Patients were identified through the Swedish Registry of Gallstone Surgery (GallRiks). Data were cross‐linked to the national registry for liver surgery (SweLiv) and the Cancer Registry. Medical records were collected if registry data were missing. Survival was measured as disease‐specific survival. The study was divided into two intervals (2007–2011 and 2012–2016) to evaluate changes over time. Results In total, 249 patients were identified with incidental gallbladder cancer, of whom 92 (36·9 per cent) underwent re‐resection with curative intent. For patients with pT2 and pT3 disease, median disease‐specific survival improved after re‐resection (12·4 versus 44·1 months for pT2, and 9·7 versus 23·0 months for pT3). Residual disease was present in 53 per cent of patients with pT2 tumours who underwent re‐resection; these patients had a median disease‐specific survival of 32·2 months, whereas the median was not reached in patients without residual disease. Median survival increased by 11 months for all patients between the early and late periods (P = 0·030). Conclusion Re‐resection of pT2 and pT3 incidental gallbladder cancer was associated with improved survival, but survival was impaired when residual disease was present. A higher re‐resection rate and more R0 resections in the later time period may have been associated with improved survival.

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“…In comparison, only GBCs at stage T1b-T3 necessitating hepatectomy were included in this research, whereas T1a tumors are adequately treated with cholecystectomy alone, and the extent of primary resection is controversial for T4 lesions. 13,14 Moreover, patients with GBC who had undergone R1 resection were excluded in the current cohort because the R0 margin is of the utmost priority in curative-intent surgery. 15 We aimed to identify the best cutoff period to define early recurrence for patients with GBC with T1b-T3 disease who have undergone R0 resection.…”

Section: Introductionmentioning

confidence: 99%

Prediction of Early Recurrence After R0 Resection for Gallbladder Carcinoma of Stage T1b–T3

Peng¹,

Nie²,

Li³

et al. 2022

CMAR

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The time-to-tumor recurrence can predict the prognosis of hepatobiliary cancers following curative-intent resection. Therefore, for patients with gallbladder carcinoma (GBC) of stage T1b-T3 who had undergone R0 resection, we investigated the risk factors for early recurrence of GBC and their prognosis. Patients and Methods: A total of 260 patients with GBC with T1b-T3 disease and an R0 margin were identified. Their clinicopathologic characteristics, perioperative details and prognostic data were reviewed. Survival analyses were carried out using the Kaplan-Meier method. Logistic regression models were used to identify the risk factors for early recurrence. Results:The optimal cutoff for early recurrence was 29 months. Early recurrence tended to result in relapse far from the primary tumor, and such patients tended to have significantly worse overall survival. Multivariate analysis revealed that T3 disease, N1/N2 stage, poor differentiation of tumor, and lymphovascular invasion (LI) were associated with a greater risk of early recurrence. Patients diagnosed as having GBC incidentally and who had the risk factors of early recurrence were more likely to benefit from re-resection 2-4 weeks after a cholecystectomy. Conclusion: T3 stage, N1-N2 stage, poor differentiation, and LI were independent risk factors associated with early recurrence for patients with GBC with stage T1b-T3 disease after R0 resection.

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High rate of positive lymph nodes in T1a gallbladder cancer does not translate to decreased survival: a population-based, propensity score adjusted analysis

Abstract: Despite a higher rate of nodal positivity among patients with T1a disease compared to previous reports, there was no impact on survival and current treatment guidelines appear appropriate for the management of T1a disease.

Cited by 13 publications

References 46 publications

The optimal number of lymph nodes to evaluate among patients undergoing surgery for gallbladder cancer: Correlating the number of nodes removed with survival in 6531 patients

The optimal number of lymph nodes to evaluate among patients undergoing surgery for gallbladder cancer: Correlating the number of nodes removed with survival in 6531 patients

Management of incidental gallbladder cancer in a national cohort

Prediction of Early Recurrence After R0 Resection for Gallbladder Carcinoma of Stage T1b–T3

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