Annals of Surgical Oncology

, Volume 19, Issue 11, pp 3567–3573 | Cite as

Definition of T3/4 and Regional Lymph Nodes in Gallbladder Cancer: Which Is More Valid, the UICC or the Japanese Staging System?

  • Yoji Kishi
  • Kazuaki Shimada
  • Shojiro Hata
  • Seiji Oguro
  • Yoshihiro Sakamoto
  • Satoshi Nara
  • Minoru Esaki
  • Nobuyoshi Hiraoka
  • Tomoo Kosuge
Hepatobiliary Tumors

Abstract

Background

The Union for International Cancer Control (UICC) and Japanese Society of Biliary Surgery (JSBS) staging systems differ in their staging of gallbladder cancer: they define hepatic invasion with or without invasion of another organ as T3 and either T3 or T4, respectively, and posterosuperior pancreatic lymph node (PSPLN) metastases as M1 and N2, respectively.

Methods

We retrospectively evaluated the survival of 224 patients who had undergone macroscopically curative resection for gallbladder cancer and assessed the influence of the differences between the two staging systems on survival.

Results

JSBS staging stratified the survival curves better for stages III or IV. Fifty-seven patients were classified as UICC-T3 but JSBS-T4. These patients had better survival than did 43 patients with UICC-T4/JSBS-T4 and comparable survival to 17 patients with UICC-T3/JSBS-T3. UICC stage IIIB is composed of two subgroups: U-T2N1 (18 patients) and U-T3N1 (21 patients). Their 5-year survivals were 85 and 41 %, respectively (P = 0.01). The latter was comparable to that of 28 T3N0 patients (35 %, P = 0.93). The survival of the UICC-M1 patients with disease restricted to PSPLNs was significantly better than that of those with involvement beyond PSPLNs (5-year survival 35 vs. 17 %; P = 0.04).

Conclusions

Although UICC staging more accurately defines the T category, JSBS staging better stratifies the prognosis of patients with gallbladder cancer, mainly because UICC stage IIIB includes T1/2N1M0, which is associated with significantly better survival than T3N0M0. It would be appropriate to classify PSPLNs as regional lymph nodes.

Keywords

Regional Lymph Node Gallbladder Cancer Adjacent Organ Gallbladder Carcinoma Extrahepatic Bile Duct 

Notes

Acknowledgment

Supported in part by a Grant-in-Aid for Young Scientists (B) (grant 23791518) from the Ministry of Education, Culture, Sports, Science and Technology.

References

  1. 1.
    Kayahara M, Nagakawa T. Recent trends of gallbladder cancer in Japan: an analysis of 4,770 patients. Cancer. 2007;110:572–80.Google Scholar
  2. 2.
    Sobin LG, Gospodarowicz MK, Wittekind Ch, editors. TNM classification of malignant tumors. 7th ed. New York: Wiley-Blackwell; 2010.Google Scholar
  3. 3.
    Edge SB, DR, Compton CC, Fritz AG, Greene FL, Trotti A, editors. AJCC cancer staging manual. 7th ed. New York: Springer; 2009.Google Scholar
  4. 4.
    Kondo S, Nimura Y, Kamiya J, et al. Factors influencing postoperative hospital mortality and long-term survival after radical resection for stage IV gallbladder carcinoma. World J Surg. 2003;27:272–7.PubMedCrossRefGoogle Scholar
  5. 5.
    Chijiiwa K, Kai M, Nagano M, Hiyoshi M, Ohuchida J, Kondo K. Outcome of radical surgery for stage IV gallbladder carcinoma. J Hepatobiliary Pancreat Surg. 2007;14:345–50.PubMedCrossRefGoogle Scholar
  6. 6.
    Nishio H, Nagino M, Ebata T, Yokoyama Y, Igami T, Nimura Y. Aggressive surgery for stage IV gallbladder carcinoma; what are the contraindications? J Hepatobiliary Pancreat Surg. 2007;14:351–7.PubMedCrossRefGoogle Scholar
  7. 7.
    Shimizu H, Kimura F, Yoshidome H, et al. Aggressive surgical approach for stage IV gallbladder carcinoma based on Japanese Society of Biliary Surgery classification. J Hepatobiliary Pancreat Surg. 2007;14:358–65.PubMedCrossRefGoogle Scholar
  8. 8.
    Shimada K, Nara S, Esaki M, Sakamoto Y, Kosuge T, Hiraoka N. Extended right hemihepatectomy for gallbladder carcinoma involving the hepatic hilum. Br J Surg. 2011;98:117–23.PubMedCrossRefGoogle Scholar
  9. 9.
    Nishio H, Ebata T, Yokoyama Y, Igami T, Sugawara G, Nagino M. Gallbladder cancer involving the extrahepatic bile duct is worthy of resection. Ann Surg. 2011;253:953–60.PubMedCrossRefGoogle Scholar
  10. 10.
    Japanese Society of Biliary Surgery. Classification of biliary tract carcinoma. 2nd ed. Tokyo: Kanehara; 2004.Google Scholar
  11. 11.
    Chijiiwa K, Noshiro H, Nakano K, et al. Role of surgery for gallbladder carcinoma with special reference to lymph node metastasis and stage using Western and Japanese classification systems. World J Surg. 2000;24:1271–6.PubMedCrossRefGoogle Scholar
  12. 12.
    Kosuge T, Sano K, Shimada K, Yamamoto J, Yamasaki S, Makuuchi M. Should the bile duct be preserved or removed in radical surgery for gallbladder cancer? Hepatogastroenterology. 1999;46:2133–7.PubMedGoogle Scholar
  13. 13.
    Sakamoto Y, Kosuge T, Shimada K, et al. Clinical significance of extrahepatic bile duct resection for advanced gallbladder cancer. J Surg Oncol. 2006;94:298–306.PubMedCrossRefGoogle Scholar
  14. 14.
    Gold DG, Miller RC, Haddock MG, et al. Adjuvant therapy for gallbladder carcinoma: the Mayo Clinic Experience. Int J Radiat Oncol Biol Phys. 2009;75:150–5.PubMedCrossRefGoogle Scholar
  15. 15.
    Miura F, Asano T, Amano H, et al. New prognostic factor influencing long-term survival of patients with advanced gallbladder carcinoma. Surgery. 2010;148:271–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Fong Y, Wagman L, Gonen M, et al. Evidence-based gallbladder cancer staging: changing cancer staging by analysis of data from the National Cancer Database. Ann Surg. 2006;243:767–71.PubMedCrossRefGoogle Scholar
  17. 17.
    Demirhan B, Bilezikci B, Haberal AN, Sevmis S, Arat Z, Haberal M. Hepatic parenchymal changes and histologic eosinophilia as predictors of subsequent acute liver allograft rejection. Liver Transpl. 2008;14:214–9.PubMedCrossRefGoogle Scholar
  18. 18.
    Araida T, Yoshikawa T, Azuma T, Ota T, Takasaki K, Hanyu F. Indications for pancreatoduodenectomy in patients undergoing lymphadenectomy for advanced gallbladder carcinoma. J Hepatobiliary pancreat Surg. 2004;11:45–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Ito H, Ito K, D’Angelica M, et al. Accurate staging for gallbladder cancer: implications for surgical therapy and pathological assessment. Ann Surg. 2011;254:320–5.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2012

Authors and Affiliations

  • Yoji Kishi
    • 1
  • Kazuaki Shimada
    • 1
  • Shojiro Hata
    • 1
  • Seiji Oguro
    • 1
  • Yoshihiro Sakamoto
    • 1
  • Satoshi Nara
    • 1
  • Minoru Esaki
    • 1
  • Nobuyoshi Hiraoka
    • 2
  • Tomoo Kosuge
    • 1
  1. 1.Hepatobiliary and Pancreatic Surgery DivisionNational Cancer Center HospitalTokyoJapan
  2. 2.Pathology DivisionNational Cancer Center Research InstituteTokyoJapan

Personalised recommendations