It remains unclear which variables –the level or the number of lymph node metastasis can predict long-term survival in patients with lymph node metastasis in advanced gallbladder cancer. The aim of this study was to assess the survival impact of lymph node metastasis from the viewpoint of the number of nodal involvements. This retrospective study was conducted on 47 patients with gallbladder cancer invading to the subserosal layer or deeper, who underwent curative resection between 1985 and 2001. Staging of the regional lymph node metastasis in UICC 5th and 6th edition were compared with the staging according to the number of positive nodes. The presence of lymph node metastasis was classified into three subgroups: Num1, metastasis in one lymph node, Num2, metastasis in two to six lymph nodes, Num3, metastasis in seven or more nodes. The 5-year survival of pT2, pT3 and pT4 was 60.4, 14.7 and 13.4%, respectively. There were 8 cases with single node metastasis. 5 year-survival rates of the patients without nodal metastasis, Num1, Num2 and Num3 were 85.7%, 42.9%, 10.7% and 0% respectively. According to UICC staging, 5 year-survival rates of the patients with pN1, pN2 and pN2> were 22.7%, 26.7 and 0%, respectively. There were no statistically significant difference between pN1 and pN2. There was no lymph node recurrence in the patients with single node metastasis. On the other hand, 13 of 21 patients with multiple nodal metastases had lymph node recurrence. As with the UICC classifications, also the classification according to the number of positive nodes retained as a significant negative prognostic factor by backward stepwise method with multivariate analysis using Cox’s proportional hazard model . In conclusion, classification according to the number of lymph node metastases is more practically useful than classification whether nodal metastasis is positive or negative in regarding to the prediction of patient’s prognosis.
[Proc Amer Assoc Cancer Res, Volume 45, 2004]