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Validation of the prognostic performance in various nodal staging systems for gallbladder cancer: results of a multicenter study

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Abstract

Background

Although the current nodal staging system for gallbladder cancer (GBC) was changed based on the number of positive lymph nodes (PLN), it needs to be evaluated in various situations.

Methods

We reviewed the clinical data for 398 patients with resected GBC and compared nodal staging systems based on the number of PLNs, the positive/retrieved LN ratio (LNR), and the log odds of positive LN (LODDS). Prognostic performance was evaluated using the C-index.

Results

Subgroups were formed on the basis of an restricted cubic spline plot as follows: PLN 3 (PLN = 0, 1–2, ≥ 3); PLN 4 (PLN = 0, 1–3, ≥ 4); LNR (LNR = 0, 0–0.269, ≥ 0.27); and LODDS (LODDS < − 0.8, − 0.8–0, ≥ 0). The oncological outcome differed significantly between subgroups in each system. In all patients with GBC, PLN 4 (C-index 0.730) and PLN 3 (C-index 0.734) were the best prognostic discriminators of survival and recurrence, respectively. However, for retrieved LN (RLN) ≥ 6, LODDS was the best discriminator for survival (C-index 0.852).

Conclusion

The nodal staging system based on PLN was the optimal prognostic discriminator in patients with RLN < 6, whereas the LODDS system is adequate for RLN ≥ 6. The following nodal staging system considers applying different systems according to the RLN.

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Acknowledgments

The authors thank the members of the Busan-Ulsan-Kyeungnam HBP Surgery Study Group of Korea for cooperating in this study and for providing the clinicopathologic information for the patients with gallbladder cancer.

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Authors and Affiliations

  1. Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University, College of Medicine, 79 Gangnam-ro, Jinju, 660-702, Republic of Korea

    Woohyung Lee, Chi-Young Jeong & Soon-Chan Hong

  2. Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Ulsan, Republic of Korea

    Woohyung Lee

  3. Department of Surgery, Dong-A University Hospital, Dong-A University, College of Medicine, Busan, Republic of Korea

    Young Hoon Kim & Young Hoon Roh

  4. Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Pusan National University, College of Medicine, Busan, Republic of Korea

    Myung Hee Yoon & Hyung Il Seo

  5. Department of Surgery, Haeundae Paik Hospital, Inje University, College of Medicine, Busan, Republic of Korea

    Jeong-Ik Park & Bo-Hyun Jung

  6. Department of Surgery, Kosin University Gospel Hospital, Kosin University, College of Medicine, Busan, Republic of Korea

    Dong Hoon Shin & Young Il Choi

  7. Department of Surgery, Pusan University Yangsan Hospital, Pusan University, College of Medicine, Busan, Republic of Korea

    Je Ho Ryu & Kwang Ho Yang

  8. Department of Surgery, College of Medicine, Inje University, Busan Paik Hospital, Busan, Republic of Korea

    Chang Soo Choi & Yo-Han Park

  9. Department of Surgery, Ulsan University Hospital, Ulsan University, College of Medicine, Ulsan, Republic of Korea

    Yang Won Nah

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  1. Woohyung Lee
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  16. Soon-Chan Hong
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Contributions

Study conception and design: Lee, Jeong, YH Kim, Yoon, Hong. Acquisition of data: Lee, KW Kim, Jung, Yang. Analysis and interpretation of data: Lee, Seo, Choi, Ryu, Hong, CS choi, Nah. Drafting of manuscript: Lee, Jeong, JI Park, Chu, Ryu, Shin. Critical revision: Lee, Jeong, Roh, Shin, Hong.

Corresponding author

Correspondence to Soon-Chan Hong.

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The authors declare that they have no competing interests.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional Research Committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Lee, W., Jeong, CY., Kim, Y.H. et al. Validation of the prognostic performance in various nodal staging systems for gallbladder cancer: results of a multicenter study. Langenbecks Arch Surg 404, 581–588 (2019). https://doi.org/10.1007/s00423-019-01807-9

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  • DOI: https://doi.org/10.1007/s00423-019-01807-9

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