Abstract
Background
The Union for International Cancer Control (UICC) and Japanese Society of Biliary Surgery (JSBS) staging systems differ in their staging of gallbladder cancer: they define hepatic invasion with or without invasion of another organ as T3 and either T3 or T4, respectively, and posterosuperior pancreatic lymph node (PSPLN) metastases as M1 and N2, respectively.
Methods
We retrospectively evaluated the survival of 224 patients who had undergone macroscopically curative resection for gallbladder cancer and assessed the influence of the differences between the two staging systems on survival.
Results
JSBS staging stratified the survival curves better for stages III or IV. Fifty-seven patients were classified as UICC-T3 but JSBS-T4. These patients had better survival than did 43 patients with UICC-T4/JSBS-T4 and comparable survival to 17 patients with UICC-T3/JSBS-T3. UICC stage IIIB is composed of two subgroups: U-T2N1 (18 patients) and U-T3N1 (21 patients). Their 5-year survivals were 85 and 41 %, respectively (P = 0.01). The latter was comparable to that of 28 T3N0 patients (35 %, P = 0.93). The survival of the UICC-M1 patients with disease restricted to PSPLNs was significantly better than that of those with involvement beyond PSPLNs (5-year survival 35 vs. 17 %; P = 0.04).
Conclusions
Although UICC staging more accurately defines the T category, JSBS staging better stratifies the prognosis of patients with gallbladder cancer, mainly because UICC stage IIIB includes T1/2N1M0, which is associated with significantly better survival than T3N0M0. It would be appropriate to classify PSPLNs as regional lymph nodes.
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References
Kayahara M, Nagakawa T. Recent trends of gallbladder cancer in Japan: an analysis of 4,770 patients. Cancer. 2007;110:572–80.
Sobin LG, Gospodarowicz MK, Wittekind Ch, editors. TNM classification of malignant tumors. 7th ed. New York: Wiley-Blackwell; 2010.
Edge SB, DR, Compton CC, Fritz AG, Greene FL, Trotti A, editors. AJCC cancer staging manual. 7th ed. New York: Springer; 2009.
Kondo S, Nimura Y, Kamiya J, et al. Factors influencing postoperative hospital mortality and long-term survival after radical resection for stage IV gallbladder carcinoma. World J Surg. 2003;27:272–7.
Chijiiwa K, Kai M, Nagano M, Hiyoshi M, Ohuchida J, Kondo K. Outcome of radical surgery for stage IV gallbladder carcinoma. J Hepatobiliary Pancreat Surg. 2007;14:345–50.
Nishio H, Nagino M, Ebata T, Yokoyama Y, Igami T, Nimura Y. Aggressive surgery for stage IV gallbladder carcinoma; what are the contraindications? J Hepatobiliary Pancreat Surg. 2007;14:351–7.
Shimizu H, Kimura F, Yoshidome H, et al. Aggressive surgical approach for stage IV gallbladder carcinoma based on Japanese Society of Biliary Surgery classification. J Hepatobiliary Pancreat Surg. 2007;14:358–65.
Shimada K, Nara S, Esaki M, Sakamoto Y, Kosuge T, Hiraoka N. Extended right hemihepatectomy for gallbladder carcinoma involving the hepatic hilum. Br J Surg. 2011;98:117–23.
Nishio H, Ebata T, Yokoyama Y, Igami T, Sugawara G, Nagino M. Gallbladder cancer involving the extrahepatic bile duct is worthy of resection. Ann Surg. 2011;253:953–60.
Japanese Society of Biliary Surgery. Classification of biliary tract carcinoma. 2nd ed. Tokyo: Kanehara; 2004.
Chijiiwa K, Noshiro H, Nakano K, et al. Role of surgery for gallbladder carcinoma with special reference to lymph node metastasis and stage using Western and Japanese classification systems. World J Surg. 2000;24:1271–6.
Kosuge T, Sano K, Shimada K, Yamamoto J, Yamasaki S, Makuuchi M. Should the bile duct be preserved or removed in radical surgery for gallbladder cancer? Hepatogastroenterology. 1999;46:2133–7.
Sakamoto Y, Kosuge T, Shimada K, et al. Clinical significance of extrahepatic bile duct resection for advanced gallbladder cancer. J Surg Oncol. 2006;94:298–306.
Gold DG, Miller RC, Haddock MG, et al. Adjuvant therapy for gallbladder carcinoma: the Mayo Clinic Experience. Int J Radiat Oncol Biol Phys. 2009;75:150–5.
Miura F, Asano T, Amano H, et al. New prognostic factor influencing long-term survival of patients with advanced gallbladder carcinoma. Surgery. 2010;148:271–7.
Fong Y, Wagman L, Gonen M, et al. Evidence-based gallbladder cancer staging: changing cancer staging by analysis of data from the National Cancer Database. Ann Surg. 2006;243:767–71.
Demirhan B, Bilezikci B, Haberal AN, Sevmis S, Arat Z, Haberal M. Hepatic parenchymal changes and histologic eosinophilia as predictors of subsequent acute liver allograft rejection. Liver Transpl. 2008;14:214–9.
Araida T, Yoshikawa T, Azuma T, Ota T, Takasaki K, Hanyu F. Indications for pancreatoduodenectomy in patients undergoing lymphadenectomy for advanced gallbladder carcinoma. J Hepatobiliary pancreat Surg. 2004;11:45–9.
Ito H, Ito K, D’Angelica M, et al. Accurate staging for gallbladder cancer: implications for surgical therapy and pathological assessment. Ann Surg. 2011;254:320–5.
Acknowledgment
Supported in part by a Grant-in-Aid for Young Scientists (B) (grant 23791518) from the Ministry of Education, Culture, Sports, Science and Technology.
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Kishi, Y., Shimada, K., Hata, S. et al. Definition of T3/4 and Regional Lymph Nodes in Gallbladder Cancer: Which Is More Valid, the UICC or the Japanese Staging System?. Ann Surg Oncol 19, 3567–3573 (2012). https://doi.org/10.1245/s10434-012-2599-5
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DOI: https://doi.org/10.1245/s10434-012-2599-5