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The optimal number of lymph nodes to evaluate among patients undergoing surgery for gallbladder cancer: Correlating the number of nodes removed with survival in 6531 patients.

Publication ,  Journal Article
Tsilimigras, DI; Hyer, JM; Paredes, AZ; Moris, D; Beal, EW; Merath, K; Mehta, R; Ejaz, A; Cloyd, JM; Pawlik, TM
Published in: Journal of surgical oncology
June 2019

The aim of the current study was to identify the minimum number and the optimal range of lymph nodes (LNs) to be examined among patients with gallbladder cancer (GBC).Between January 1, 2004, and December 31, 2015, patients with a diagnosis of GBC were identified in the National Cancer Database. A machine-based learning approach was used to identify the minimum number and range of LNs to evaluate relative to long-term outcomes.Among 6531 patients with GBC, median number of LNs evaluated was 2 (IQR:1-5); only 21.1% (n = 1376) of patients had 6 or more LNs evaluated. The median number of metastatic LNs was 0 (IQR: 0-1). On multivariable analysis, evaluation of < 4 LNs was associated with a higher hazard of death (referent 4-7 LNs: < 4 LNs, HR = 1.27, 95% CI, 1.16-1.40; P < 0.001), whereas, patients who had 4 to 7 LNs and > 7 LNs evaluated had comparable long-term mortality risk (HR = 1.10, 95%CI, 0.98-1.24; P = 0.11). There was no difference in the proportion of patients who had at least one metastatic LN identified per T category based on total number of nodes resected (all P > 0.05).The overwhelming majority of patients did not have the American Joint Committee on Cancer (AJCC) recommended 6 total LN count . A machine-based learning approach identified evaluation of 4 to 7 LNs as the LN number associated with optimal staging and survival. While obtaining 6 LNs may be challenging, evaluation of at least 4 LNs may be a more appropriate threshold as this cut-off value was associated with optimal patient outcomes and staging.

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Published In

Journal of surgical oncology

DOI

EISSN

1096-9098

ISSN

0022-4790

Publication Date

June 2019

Volume

119

Issue

8

Start / End Page

1099 / 1107

Related Subject Headings

  • United States
  • Oncology & Carcinogenesis
  • Neoplasm Staging
  • Middle Aged
  • Male
  • Machine Learning
  • Lymphatic Metastasis
  • Lymph Nodes
  • Lymph Node Excision
  • Kaplan-Meier Estimate
 

Citation

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Tsilimigras, D. I., Hyer, J. M., Paredes, A. Z., Moris, D., Beal, E. W., Merath, K., … Pawlik, T. M. (2019). The optimal number of lymph nodes to evaluate among patients undergoing surgery for gallbladder cancer: Correlating the number of nodes removed with survival in 6531 patients. Journal of Surgical Oncology, 119(8), 1099–1107. https://doi.org/10.1002/jso.25450
Tsilimigras, Diamantis I., J Madison Hyer, Anghela Z. Paredes, Dimitrios Moris, Eliza W. Beal, Katiuscha Merath, Rittal Mehta, Aslam Ejaz, Jordan M. Cloyd, and Timothy M. Pawlik. “The optimal number of lymph nodes to evaluate among patients undergoing surgery for gallbladder cancer: Correlating the number of nodes removed with survival in 6531 patients.Journal of Surgical Oncology 119, no. 8 (June 2019): 1099–1107. https://doi.org/10.1002/jso.25450.
Tsilimigras DI, Hyer JM, Paredes AZ, Moris D, Beal EW, Merath K, et al. The optimal number of lymph nodes to evaluate among patients undergoing surgery for gallbladder cancer: Correlating the number of nodes removed with survival in 6531 patients. Journal of surgical oncology. 2019 Jun;119(8):1099–107.
Tsilimigras, Diamantis I., et al. “The optimal number of lymph nodes to evaluate among patients undergoing surgery for gallbladder cancer: Correlating the number of nodes removed with survival in 6531 patients.Journal of Surgical Oncology, vol. 119, no. 8, June 2019, pp. 1099–107. Epmc, doi:10.1002/jso.25450.
Tsilimigras DI, Hyer JM, Paredes AZ, Moris D, Beal EW, Merath K, Mehta R, Ejaz A, Cloyd JM, Pawlik TM. The optimal number of lymph nodes to evaluate among patients undergoing surgery for gallbladder cancer: Correlating the number of nodes removed with survival in 6531 patients. Journal of surgical oncology. 2019 Jun;119(8):1099–1107.
Journal cover image

Published In

Journal of surgical oncology

DOI

EISSN

1096-9098

ISSN

0022-4790

Publication Date

June 2019

Volume

119

Issue

8

Start / End Page

1099 / 1107

Related Subject Headings

  • United States
  • Oncology & Carcinogenesis
  • Neoplasm Staging
  • Middle Aged
  • Male
  • Machine Learning
  • Lymphatic Metastasis
  • Lymph Nodes
  • Lymph Node Excision
  • Kaplan-Meier Estimate