ABSTRACT
HYPOTHESIS: Extended surgical resection (ESR) may improve survival in patients with early-stage primary gallbladder cancer. DESIGN: Retrospective analysis of findings in the Surveillance, Epidemiology, and End Results (SEER) database. SETTING: Academic research. PATIENTS: Individuals with potentially surgically curable gallbladder cancer (Tis, T1, or T2) who underwent a surgical procedure. MAIN OUTCOME MEASURES: Overall survival, number of lymph nodes (LNs) excised, and results of simple cholecystectomy vs ESR. RESULTS: We identified 3209 patients with early-stage gallbladder cancer (11.7% Tis, 30.1% T1, and 58.2% T2). On multivariate analysis, decreased survival was noted among patients older than 60 years (hazard ratio, 1.57; 95% confidence interval, 1.30-1.90), among patients with more advanced cancer (1.99; 1.46-2.70 for T1; 3.29; 2.45-4.43 for T2), and among patients with disease-positive LNs (1.65; 1.39-1.95 for regional; 2.58; 1.54-4.34 for distant) (P < .001 for all), while increased survival was observed among female patients (0.82; 0.70-0.96; P = .02) and among patients undergoing ESR (0.59; 0.45-0.78; P < .001). The survival advantage of ESR was seen only in patients with T2 lesions (0.49; 0.35-0.68; P < .001). Lymph node excision data were available for a subset of 2507 patients, of whom 68.2% had no LN excised, 28.2% had 1 to 4 LNs excised, and 3.6% had 5 or more LNs excised. On multivariate analysis, patients with 1 to 4 LNs excised had a survival benefit over those with no LN excised (HR, 0.55; 95% CI, 0.46-0.66; P < .001), and patients with 5 or more LNs excised had a survival benefit over patients with 1 to 4 LNs removed (0.63; 0.40-0.96; P = .03). Lymph node excision improved survival in patients with T2 lesions (0.42; 0.33-0.53; P < .001 for patients with 1-4 LNs excised). CONCLUSION: Extended surgical resection, LN excision, or both may improve survival in certain patients with incidentally discovered gallbladder cancer.
Subject(s)
Cholecystectomy , Gallbladder Neoplasms/surgery , Lymph Node Excision , Aged , Aged, 80 and over , Female , Gallbladder Neoplasms/mortality , Gallbladder Neoplasms/pathology , Humans , Male , Middle Aged , Proportional Hazards Models , SEER Program , Survival RateABSTRACT
BACKGROUND: Much debate exists over the significance of the number of lymph nodes (LN) examined after colon resection. MATERIALS AND METHODS: The Surveillance, Epidemiology and End Results (SEER) database was queried for patients who presented with colonic adenocarcinoma. Multiple Cox proportional hazard regressions were run using successive LN cut-offs (6-26), first controlling for and then stratifying by T-stage. This was repeated in subsets of patients delineated by LN status. Additional variables controlled for in every regression were age, gender, ethnicity, marital status, number of positive LN, grade, metastases, and extent of surgery. After each regression, a Harrell's C statistic and an Akaike's information criterion (AIC) were performed to test the predictive capacity and fit of the model, respectively. RESULTS: 128,071 patients met selection criteria. The highest Harrell's C statistics among all patients were the cutoffs at 14 LN and 15 LN. Between those, the AIC shows that the cutoff at 15 LN fit the data more closely than the 14 LN cutoff. The models with the best predictive ability and best fit by T-stage were T1, 14 LN; T2, 10 LN; T3, 10 LN; T4, 12 LN. CONCLUSIONS: Using a population-based dataset, we show the optimal number of LN examined is dependent upon the patient's tumor stage. Across all T-stages, the highest optimal number of LN resected was 15. Since it is possible to estimate but not perfectly predict the stage of a patient's tumor preoperatively, we believe the recommendation should be based on the most conservative measure.
