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Comparison of Number Versus Ratio of Positive Lymph Nodes in the Assessment of Lymph Node Status in Extrahepatic Cholangiocarcinoma

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

This study aimed to compare the utility of the number of positive lymph nodes with the lymph node ratio (LNR) in predicting survival after resection of extrahepatic cholangiocarcinoma.

Methods

A retrospective analysis of 142 consecutive patients who underwent radical resection of extrahepatic cholangiocarcinoma was performed. A total of 3066 regional lymph nodes were resected. The median number of nodes per patient was 21. The optimal cutoff values for the number of positive nodes and the LNR were determined using the Chi square scores calculated by the Cox proportional hazards regression model.

Results

Nodal disease was found in 59 patients (42 %). In the subsequent analysis of the impact that nodal status has on survival, 18 patients with R1/2 resection and 6 patients with paraaortic nodal disease who did not survive for more than 5 years after resection were excluded. The optimal cutoff value for the number of positive nodes was 1, and the optimal cutoff value for the LNR was 5 %. Univariate analysis identified both the number of positive nodes (0, 1, or ≥2; P = 0.005) and the LNR (0, 0–5, or >5 %; P = 0.007) as significant prognostic factors. Multivariate analysis identified the number of positive nodes but not the LNR as an independent prognostic factor (P = 0.012). The 5-year survival rates were 64 % for the patients with no positive nodes, 46 % for the patients with one positive node, and 28 % for the patients with two or more positive nodes.

Conclusions

The number of positive lymph nodes predicts survival better than the LNR after resection of extrahepatic cholangiocarcinoma, provided that nodal evaluation is sufficient.

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Conflict of interest

There are no conflicts of interest.

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Authors and Affiliations

  1. Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan

    Jun Sakata MD, Toshifumi Wakai MD, Taku Ohashi MD, Yuki Hirose MD, Hiroshi Ichikawa MD, Takashi Kobayashi MD, Masahiro Minagawa MD, Shin-ichi Kosugi MD & Yu Koyama MD

  2. Department of Medical Technology, Niigata University Graduate School of Health Sciences, Niigata, Japan

    Yasunobu Matsuda MD

  3. Department of Medical Informatics, Niigata University Medical and Dental Hospital, Niigata, Japan

    Kouhei Akazawa PhD

  4. Division of Molecular and Diagnostic Pathology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan

    Yoichi Ajioka MD, PhD

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  1. Jun Sakata MD
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  2. Toshifumi Wakai MD
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  3. Yasunobu Matsuda MD
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  12. Yoichi Ajioka MD, PhD
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Correspondence to Jun Sakata MD.

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Sakata, J., Wakai, T., Matsuda, Y. et al. Comparison of Number Versus Ratio of Positive Lymph Nodes in the Assessment of Lymph Node Status in Extrahepatic Cholangiocarcinoma. Ann Surg Oncol 23, 225–234 (2016). https://doi.org/10.1245/s10434-015-4609-x

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  • DOI: https://doi.org/10.1245/s10434-015-4609-x

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