What is the most accurate lymph node staging method for perihilar cholangiocarcinoma? Comparison of UICC/AJCC pN stage, number of metastatic lymph nodes, lymph node ratio, and log odds of metastatic lymph nodes

Conci, Simone; Ruzzenente, Andrea; Sandri, Marco; Bertuzzo, Francesca; Campagnaro, Tommaso; Bagante, Fabio; Capelli, Paola; D’Onofrio, Mirko; Piccino, Marco; Dorna, A.; Pedrazzani, Corrado; Iacono, Calogero; Guglielmi, Alfredo

doi:10.1016/j.ejso.2016.12.007

Cited by 48 publications

(47 citation statements)

References 28 publications

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“…Thirty‐one articles underwent initial qualitative assessment, of which seven were subsequently excluded, two owing to data duplication. The remaining five articles were excluded because of variable data reporting: one had trichotomized data, from which no meaningful data could be acquired; one did not report a primary series; one did not report prognostic variables for OS; one provided survival data only for patients with N0 disease; and one did not provide consistent numbers for overall survivors.…”

Section: Resultsmentioning

confidence: 99%

Meta-analysis of prognostic factors for overall survival in patients with resected hilar cholangiocarcinoma

Bird

McKenna

Dodd

et al. 2018

British Journal of Surgery

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Section: Resultsmentioning

confidence: 99%

Meta-analysis of prognostic factors for overall survival in patients with resected hilar cholangiocarcinoma

Bird

McKenna

Dodd

et al. 2018

British Journal of Surgery

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“…The limits of LNR for PHCC patients have been also underlined by Conci et al who recently compared the different approaches used to stage the lymph node status of patients who underwent hepatectomy for PHCC at the University of Verona between September 1990 and December 2014 (28). The mathematical transformation of the ratio between the number of lymph nodes harvested and the number of metastatic lymph nodes (log odds of metastatic lymph nodes, LODDS) was the factor with the highest area under the receiver operating characteristic curve (AUC) predicting the 3-year OS (AUC = 0.71) compared with lymph node ratio (LNR, AUC = 0.60), number of metastatic lymph node (AUC = 0.59), and AJCC 7th edition N-staging (AUC = 0.54) (28). The authors determined that while the mathematical transformation of number of metastatic lymph node and number of harvested lymph nodes as LNR and LODDS are better predictors of survival than AJCC N staging, LODDS resulted the most accurate and predictive lymph node staging for patients undergoing curative intent surgery for PHCC.…”

Section: Other Methods To Prognostically Other Methods To Prognosticamentioning

confidence: 98%

Prognostic Significance of Lymph Node Ratio After Resection of Peri-hilar Cholangiocarcinoma

Guglielmi¹,

Ruzzenete²,

Bagante³

et al. 2018

SGO

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Even though lymph node status is one of the most important predictors of survival for patients undergoing curative-intent surgery for peri-hilar cholangiocarcinoma (PHCC), the optimal lymph node staging system for PHCC has not been identified. Recently, the newly published 8th edition of the American Joint Committee on Cancer (AJCC) staging system reformed the criteria used to stage the lymph node status of PHCC patients but this change did not demonstrate to significantly improve the prognostic stratification of patients with PHCC. Among the several clinical tools that have been proposed in replacement of the AJCC N stages, the lymph node ratio (LNR) defined as the ratio of the number of metastatic lymph nodes to the number of lymph nodes harvested, demonstrated to improve the lymph node staging of patients with several gastrointestinal and hepatobiliary cancers. When tested in PHCC patients, while LNR was associated with patients' prognosis, the prognostic performances of LNR were strongly influenced by the number of lymph node harvested suggesting that LNR might be of less clinical value in PHCC patients due to the relatively small number of lymph node harvested compared with other gastrointestinal cancers. While other clinical tool (i.e. LODDS) has been proposed to assess lymph node status, further studies are needed to improve the lymph nodal staging of PHCC patients.

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“…Increasing rates of caudate lobectomy were reported in large series of curative intent surgery for PHC published in the last 5 years: 35.3% -100%. The adoption rate of en bloc caudate lobectomy appears to remain higher in East Asian surgical centres, compared to Western centres (7,21,(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55).…”

Section: Caudate Lobectomy -How Frequent Is It Used In Surgery For Phc?mentioning

confidence: 95%

Caudate Lobectomy for Perihilar Cholangiocarcinoma - Current Evidence

Dumitraşcu¹,

Ionescu²

2019

chr

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Chirurgia reprezintă singura şansă de supravieţuire pe termen lung pentru pacienţii diagnosticaţi cu colangiocarcinom perihilar. Rezecţia cu viză curativă a cunoscut de-a lungul anilor îmbunătăţiri semnificative, pornind de la rezecţia doar a căii biliare principale şi ajungând la proceduri chirurgicale complexe ce includ limfodisecţia loco-regională, rezecţii hepatice majore şi, uneori, rezecţii vasculare asociate. Acest tip modern de abord chirurgical a dus la îmbunătăţirea substanţială a supravieţuirii acestor pacienţi, în pofida unei rate mari de complicaţii postoperatorii. În Europa şi America, rezulatele iniţiale ale acestui tip complex de abord chirurgical incluzând rezecţii hepatice majore au fost dezamăgitoare deoarece s-au asociat cu rate ale mortalităţii postoperatorii inacceptabil de mari. Astăzi, mortalitatea după rezecţia colangiocarcinoamelor perihilare a scăzut semificativ, dar totuşi rata mortalităţii în centrele din Europa şi America rămâne mai mare decât rata raportată în centrele din Estul Asiei. Aceste diferenţe de rezultate între centrele din Europa-America şi Estul Asiei nu sunt explicate doar prin diferenţele de abord terapeutic dar şi de caracteristicile diferite ale pacienţilor din cele două părţi ale lumii. Rezecţia în bloc a lobului caudat ca parte a rezecţiilor radicale pentru colangiocarcinoame perihilare a fost introdusă în practica clinică de mai bine de trei decenii. Susţinerea rezecţiei de lob caudat se bazează pe modalitatea de răspandire locală a acestui tip de tumori precum şi pe faptul că invazia de lob caudat este un fapt frecvent întâlnit în acest tip de tumori. Rezecţia de lob

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What is the most accurate lymph node staging method for perihilar cholangiocarcinoma? Comparison of UICC/AJCC pN stage, number of metastatic lymph nodes, lymph node ratio, and log odds of metastatic lymph nodes

Cited by 48 publications

References 28 publications

Meta-analysis of prognostic factors for overall survival in patients with resected hilar cholangiocarcinoma

Meta-analysis of prognostic factors for overall survival in patients with resected hilar cholangiocarcinoma

Prognostic Significance of Lymph Node Ratio After Resection of Peri-hilar Cholangiocarcinoma

Caudate Lobectomy for Perihilar Cholangiocarcinoma - Current Evidence

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