Survival analysis following resection of AJCC stage III gallbladder carcinoma based on different combinations of T and N stages.
10.14701/kjhbps.2015.19.1.11
- Author:
Kyoung Yeon HWANG
1
;
Young In YOON
;
Shin HWANG
;
Tae Yong HA
;
Chul Soo AHN
;
Ki Hun KIM
;
Deok Bog MOON
;
Gi Won SONG
;
Dong Hwan JUNG
;
Young Joo LEE
;
Kwang Min PARK
;
Sung Gyu LEE
Author Information
1. Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. shwang@amc.seoul.kr
- Publication Type:Original Article
- Keywords:
Gallbladder carcinoma;
Survival analysis;
Resection;
Lymph node metastasis
- MeSH:
Bile Ducts;
Follow-Up Studies;
Gallbladder*;
Humans;
Liver;
Lymph Nodes;
Neoplasm Metastasis;
Neoplasm Micrometastasis;
Neoplasm Staging;
Prognosis;
Survival Analysis*;
Survival Rate
- From:Korean Journal of Hepato-Biliary-Pancreatic Surgery
2015;19(1):11-16
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUNDS/AIMS: According to 7th AJCC TNM staging system, gallbladder carcinoma (GBC) with lymph node (LN) metastasis is classified as N1 or N2; thus making the stage IIIB (N1) or IVB (N2). Stage IIIB consists of N1 status with wide coverage of T1-3, but T3N1 group often showed poorer outcomes than T1-2N1 groups. This study intended to assess post-resection prognosis of T3N1 versus other stage III subgroups. METHODS: We selected 103 patients from our institutional database of GBC who underwent R0 resection between July 1996 and June 2009 and whose GBC was confined to stage T3N0, T1-3N1 or T1-3N2. These patients were stratified into five groups, namely, T3N0 (n=26), T1N1 (n=13), T2N1 (n=35), T3N1 (n=20) and T1-3N2 (n=9), and were followed for > or =5 years or until death. RESULTS: Surgical procedures were minor liver resection (n=53), minor liver resection with bile duct resection (n=23), major liver resection (n=12), major liver resection with bile duct resection (n=5), and hepatopancreatoduodenectomy (n=12). Mean follow-up period was 57.2+/-68.5 months. Overall 5-year survival rate based on all-cause death and cancer-associated death, respectively, was 57.7% and 60.6% in T3N0, 15.4% and 15.4% in T1N1 (n=13), 28.6% and 28.6% in T2N1 (n=35), 5.0% and 5.7% in T3N1 (n=20), and 22.2% and 22.2% in T1-3N2. The survival outcome of T3N1 group was the poorest among the four stage III groups and was comparable to that of stage IVB (p=0.53). CONCLUSIONS: The prognosis of T3N1 GBC is unusually poor even after R0 resection, thus we suggest extensive LN dissection may be necessary in patients with T3 tumors for accurate prognostic evaluation and radical removal of potential nodal micrometastasis. Further validation of this result is necessary in large patient populations from multiple centers.
