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. 2023 Sep 28;408(1):382.
doi: 10.1007/s00423-023-03119-5.

Metastatic lymph node ratio as an important prognostic factor in advanced gallbladder carcinoma with at least 6 lymph nodes retrieved

Junke Wang #  1 , Fei Liu #  1 , Wenjie Ma  1 , Haijie Hu  1 , Fuyu Li  2
Affiliations

Metastatic lymph node ratio as an important prognostic factor in advanced gallbladder carcinoma with at least 6 lymph nodes retrieved

Junke Wang et al. Langenbecks Arch Surg. .

Abstract

Background: The metastatic lymph node (LN) ratio (LNR) has shown to be an important prognostic factor in various gastrointestinal malignancies. Nevertheless, the prognostic significance of LNR in gallbladder carcinoma (GBC) remains to be determined.

Methods: From January 2007 to January 2018, 144 advanced GBC patients (T2-4 stages) who underwent curative surgery with at least 6 LNs retrieved were enrolled. Receiver operating characteristic (ROC) curve was performed to identify the optimal cut-off value for LNR. The clinicopathological features stratified by LNR level were analyzed. Meanwhile, univariate and multivariate Cox regression proportional hazard models were performed to identify risk factors for overall survival (OS).

Results: The optimal cut-off point for LNR was 0.28 according to the ROC curve. LNR>0.28 was associated with higher rate of D2 LN dissection (P=0.004) and higher tumor stages (P<0.001). Extent of liver resection, extrahepatic bile duct resection, tumor stage, LNR, margin status, tumor differentiation, and perineural invasion were associated with OS in univariate analysis (all P<0.05). GBC patients with LNR≤0.28 had a significantly longer median OS compared to those with LNR>0.28 (27.5 vs 18 months, P=0.004). Multivariate analysis indicated that tumor stage (T2 vs T3/T4; hazard ratio (HR) 1.596; 95% confidence interval (CI) 1.195-2.132), LNR (≤0.28 vs >0.28; HR 0.666; 95% CI 0.463-0.958), margin status (R0 vs R1; HR 1.828; 95% CI 1.148-2.910), and tumor differentiation (poorly vs well/moderately; HR 0.670; 95% CI 0.589-0.892) were independent prognostic factors for GBC (all P<0.05).

Conclusions: LNR is correlated to advanced GBC prognosis and is a potential prognostic factor for advanced GBC with at least 6 LNs retrieved.

Keywords: Gallbladder carcinoma; Metastatic lymph node ratio; Prognostic factor.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart showing patients selection
Fig. 2
Fig. 2
Optimal cut-off point for the LNR was identified by ROC curve analysis
Fig. 3
Fig. 3
Kaplan-Meier survival curves of patients with advanced GBC. A The OS curve of entire 144 patients; B The DFS curve of entire 144 patients; C OS comparison between patients with LNR≤0.28 and LNR>0.28
Fig. 4
Fig. 4
Subgroups of Kaplan-Meier OS curves between patients with LNR≤0.28 and LNR>0.28. A T2 stage; B T3 stage; C T4 stage
Fig. 5
Fig. 5
Subgroups of Kaplan-Meier OS curves between patients with LNR≤0.28 and LNR>0.28. A D1 LN dissection; B D2 LN dissection
Fig. 6
Fig. 6
Kaplan-Meier OS curves between patients with or without postoperative chemotherapy. A LNR≤0.28; B LNR>0.28
See this image and copyright information in PMC

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