Impact of the number of examined lymph nodes on outcomes in patients with lymph node-negative gallbladder carcinoma

Abstract

AIMTo determine whether the number of examined lymph nodes (LNs) is correlated with the overall survival of gallbladder carcinoma (GBC) patients.METHODSPatients were collected from the Surveillance Epidemiology and End Results database (2004-2013) and categorized by the number of LNs into six groups: 1 LN, 2 LNs, 3 LNs, 4 LNs, 5 LNs, and ≥ 6 LNs. Survival curves for overall survival were plotted with a Kaplan-Meier analysis. The log-rank test was used for univariate comparisons.RESULTSIn a cohort of 893 patients, the median number of examined LNs was two for the entire cohort. The survival for the 1 LN group was significantly poorer than those of the stage I and II disease groups and for the entire cohort. By dichotomizing the number of LNs from 1 to 6, we found that the minimum number of LNs that should be examined was four for stage I, four or five for stage II, and six for stage IIIA disease. Therefore, for the entire cohort, the number of examined LNs should be at least six, which is exactly consistent with the American Joint Committee on Cancer criteria.CONCLUSIONThe examination of higher numbers of LNs is associated with improved survival after resection surgery for N0 GBC. The guidelines for GBC surgery, which recommend that six LNs be examined at least, are statistically valid and should be applied in clinical practice widely.

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

“…For example, utilizing the Surveillance, Epidemiology, and End Result (SEER) database, Fan et al reported that longer survival was observed when 4 LNs were evaluated among patients with stage I disease, 4 or 5 LNs for stage II, and 6 for stage IIIA disease . Of note, the authors reported that the evaluation of 4 to 6 LNs was the optimal TLNC when examining the entire cohort ( P < 0.001) . Similarly, in the current study utilizing the NCBD, we noted that evaluate of 4 to 7 nodes was the optimal number of LNs relative to survival and staging.…”

“…To the best of our knowledge, this is the first study to use a machine-learning approach to identify the optimal TLNC relative to a long-term survival among patients with GBC. 20 Of note, the authors reported that the evaluation of 4 to 6 LNs was the optimal TLNC when examining the entire cohort (P < 0.001). 20 Similarly, in the current study utilizing the NCBD, we noted that evaluate of 4 to 7 nodes was the optimal number of LNs relative to survival and staging.…”

“…20 Of note, the authors reported that the evaluation of 4 to 6 LNs was the optimal TLNC when examining the entire cohort (P < 0.001). 20 Similarly, in the current study utilizing the NCBD, we noted that evaluate of 4 to 7 nodes was the optimal number of LNs relative to survival and staging. own group previously demonstrated that LODDS performed better than the AJCC LN staging system in terms of prognostic discrimination among patient with GBC.…”

“…Several studies had previously demonstrated a relationship between the number of LNs evaluated and OS among patients with surgically resected N0 GBC . For example, utilizing the Surveillance, Epidemiology, and End Result (SEER) database, Fan et al reported that longer survival was observed when 4 LNs were evaluated among patients with stage I disease, 4 or 5 LNs for stage II, and 6 for stage IIIA disease . Of note, the authors reported that the evaluation of 4 to 6 LNs was the optimal TLNC when examining the entire cohort ( P < 0.001) .…”

Survival benefit of lymphadenectomy for gallbladder cancer based on the therapeutic index: An analysis of the US extrahepatic biliary malignancy consortium

“…For example, Ito et al reported that survival of patients classified as N0 based on less than six LNs harvested was significantly worse than that of N0 patients based on ≥6 LNs harvested. In addition, an analysis of the Surveillance, Epidemiology, and End Result database reported that among patients with stage I, II, and IIIA disease, longer survival was observed when four LNs, four or five LNs, and six LNs were evaluated, respectively . While the recommended number of LNs to evaluate for GBC was 3 in the 6th edition of the AJCC staging manual, the most current 8th AJCC edition recommends at least six LNs be evaluated to adequately stage patients with GBC .…”