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

  • Woohyung Lee
  • Chi-Young Jeong
  • Young Hoon Kim
  • Young Hoon Roh
  • Myung Hee Yoon
  • Hyung Il Seo
  • Jeong-Ik Park
  • Bo-Hyun Jung
  • Dong Hoon Shin
  • Young Il Choi
  • Je Ho Ryu
  • Kwang Ho Yang
  • Chang Soo Choi
  • Yo-Han Park
  • Yang Won Nah
  • Soon-Chan HongEmail author
Original Article



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.


Gallbladder 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.

Author 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.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

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

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

Supplementary material

423_2019_1807_MOESM1_ESM.docx (49 kb)
ESM 1 (DOCX 49 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Woohyung Lee
    • 1
    • 2
  • Chi-Young Jeong
    • 1
  • Young Hoon Kim
    • 3
  • Young Hoon Roh
    • 3
  • Myung Hee Yoon
    • 4
  • Hyung Il Seo
    • 4
  • Jeong-Ik Park
    • 5
  • Bo-Hyun Jung
    • 5
  • Dong Hoon Shin
    • 6
  • Young Il Choi
    • 6
  • Je Ho Ryu
    • 7
  • Kwang Ho Yang
    • 7
  • Chang Soo Choi
    • 8
  • Yo-Han Park
    • 8
  • Yang Won Nah
    • 9
  • Soon-Chan Hong
    • 1
    Email author
  1. 1.Department of Surgery, Gyeongsang National University HospitalGyeongsang National University, College of MedicineJinjuRepublic of Korea
  2. 2.Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Asan Medical CenterUniversity of Ulsan College of MedicineUlsanRepublic of Korea
  3. 3.Department of Surgery, Dong-A University HospitalDong-A University, College of MedicineBusanRepublic of Korea
  4. 4.Department of Surgery, Biomedical Research Institute, Pusan National University HospitalPusan National University, College of MedicineBusanRepublic of Korea
  5. 5.Department of Surgery, Haeundae Paik HospitalInje University, College of MedicineBusanRepublic of Korea
  6. 6.Department of Surgery, Kosin University Gospel HospitalKosin University, College of MedicineBusanRepublic of Korea
  7. 7.Department of Surgery, Pusan University Yangsan HospitalPusan University, College of MedicineBusanRepublic of Korea
  8. 8.Department of Surgery, College of MedicineInje University, Busan Paik HospitalBusanRepublic of Korea
  9. 9.Department of Surgery, Ulsan University HospitalUlsan University, College of MedicineUlsanRepublic of Korea

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