Validation of the prognostic performance in various nodal staging systems for gallbladder cancer: results of a multicenter study
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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.
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.
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).
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.
KeywordsGallbladder cancer Prognostic performance Staging system Restricted cubic spline model
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.
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.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no competing interests.
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.
Informed consent was obtained from all individual participants included in the study.
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