Perihilar Cholangiocarcinoma: Number of Nodes Examined and Optimal Lymph Node Prognostic Scheme

Fabio Bagante; Thuy Tran; Gaya Spolverato; Andrea Ruzzenente; Stefan Buttner; Cecilia G. Ethun; Bas Groot Koerkamp; Simone Conci; Kamran Idrees; Chelsea A. Isom; Ryan C. Fields; Bradley Krasnick; Sharon M. Weber; Ahmed Salem; Robert C G Martin; Charles Scoggins; Perry Shen; Harveshp D. Mogal; Carl Schmidt; Eliza Beal; Ioannis Hatzaras; Gerardo Vitiello; Jan N M Ijzermans; Shishir K. Maithel; George Poultsides; Alfredo Guglielmi; Timothy M. Pawlik

doi:10.1016/j.jamcollsurg.2016.02.012

Perihilar Cholangiocarcinoma: Number of Nodes Examined and Optimal Lymph Node Prognostic Scheme

Fabio Bagante, Thuy Tran, Gaya Spolverato, Andrea Ruzzenente, Stefan Buttner, Cecilia G. Ethun, Bas Groot Koerkamp, Simone Conci, Kamran Idrees, Chelsea A. Isom, Ryan C. Fields, Bradley Krasnick, Sharon M. Weber, Ahmed Salem, Robert C G Martin, Charles Scoggins, Perry Shen, Harveshp D. Mogal, Carl Schmidt, Eliza BealIoannis Hatzaras, Gerardo Vitiello, Jan N M Ijzermans, Shishir K. Maithel, George Poultsides, Alfredo Guglielmi, Timothy M. Pawlik

School of Medicine

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Abstract

Background The role of routine lymphadenectomy for perihilar cholangiocarcinoma is still controversial and no study has defined the minimum number of lymph nodes examined (TNLE). We sought to assess the prognostic performance of American Joint Committee on Cancer/Union Internationale Contre le Cancer (7^th edition) N stage, lymph node ratio, and log odds (LODDS; logarithm of the ratio between metastatic and nonmetastatic nodes) in patients with perihilar cholangiocarcinoma and identify the optimal TNLE to accurately stage patients. Methods A multi-institutional database was queried to identify 437 patients who underwent hepatectomy for perihilar cholangiocarcinoma between 1995 and 2014. The prognostic abilities of the lymph node staging systems were assessed using the Harrell's c-index. A Bayesian model was developed to identify the minimum TNLE. Results One hundred and fifty-eight (36.2%) patients had lymph node metastasis. Median TNLE was 3 (interquartile range, 1 to 7). The LODDS had a slightly better prognostic performance than lymph node ratio and American Joint Committee on Cancer, in particular among patients with 2, the hazard ratio for N1 patients was statistically significant and the hazard ratio for N1 patients increased from 1.51 with 4 TNLE to 2.10 with 10 TNLE. Although the 5-year overall survival of N1 patients was only slightly affected by TNLE, the 5-year overall survival of N0 patients increased significantly with TNLE. Conclusions Perihilar cholangiocarcinoma patients undergoing radical resection should ideally have at least 4 lymph nodes harvested to be accurately staged. In addition, although LODDS performed better at determining prognosis among patients with

Original language	English (US)
Pages (from-to)	750-759e2
Journal	Journal of the American College of Surgeons
Volume	222
Issue number	5
DOIs	https://doi.org/10.1016/j.jamcollsurg.2016.02.012
State	Published - May 1 2016

ASJC Scopus subject areas

Surgery

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10.1016/j.jamcollsurg.2016.02.012

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Bagante, F., Tran, T., Spolverato, G., Ruzzenente, A., Buttner, S., Ethun, C. G., Koerkamp, B. G., Conci, S., Idrees, K., Isom, C. A., Fields, R. C., Krasnick, B., Weber, S. M., Salem, A., Martin, R. C. G., Scoggins, C., Shen, P., Mogal, H. D., Schmidt, C., ... Pawlik, T. M. (2016). Perihilar Cholangiocarcinoma: Number of Nodes Examined and Optimal Lymph Node Prognostic Scheme. Journal of the American College of Surgeons, 222(5), 750-759e2. https://doi.org/10.1016/j.jamcollsurg.2016.02.012

Bagante, F, Tran, T, Spolverato, G, Ruzzenente, A, Buttner, S, Ethun, CG, Koerkamp, BG, Conci, S, Idrees, K, Isom, CA, Fields, RC, Krasnick, B, Weber, SM, Salem, A, Martin, RCG, Scoggins, C, Shen, P, Mogal, HD, Schmidt, C, Beal, E, Hatzaras, I, Vitiello, G, Ijzermans, JNM, Maithel, SK, Poultsides, G, Guglielmi, A & Pawlik, TM 2016, 'Perihilar Cholangiocarcinoma: Number of Nodes Examined and Optimal Lymph Node Prognostic Scheme', Journal of the American College of Surgeons, vol. 222, no. 5, pp. 750-759e2. https://doi.org/10.1016/j.jamcollsurg.2016.02.012

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title = "Perihilar Cholangiocarcinoma: Number of Nodes Examined and Optimal Lymph Node Prognostic Scheme",

abstract = "Background The role of routine lymphadenectomy for perihilar cholangiocarcinoma is still controversial and no study has defined the minimum number of lymph nodes examined (TNLE). We sought to assess the prognostic performance of American Joint Committee on Cancer/Union Internationale Contre le Cancer (7th edition) N stage, lymph node ratio, and log odds (LODDS; logarithm of the ratio between metastatic and nonmetastatic nodes) in patients with perihilar cholangiocarcinoma and identify the optimal TNLE to accurately stage patients. Methods A multi-institutional database was queried to identify 437 patients who underwent hepatectomy for perihilar cholangiocarcinoma between 1995 and 2014. The prognostic abilities of the lymph node staging systems were assessed using the Harrell's c-index. A Bayesian model was developed to identify the minimum TNLE. Results One hundred and fifty-eight (36.2%) patients had lymph node metastasis. Median TNLE was 3 (interquartile range, 1 to 7). The LODDS had a slightly better prognostic performance than lymph node ratio and American Joint Committee on Cancer, in particular among patients with 2, the hazard ratio for N1 patients was statistically significant and the hazard ratio for N1 patients increased from 1.51 with 4 TNLE to 2.10 with 10 TNLE. Although the 5-year overall survival of N1 patients was only slightly affected by TNLE, the 5-year overall survival of N0 patients increased significantly with TNLE. Conclusions Perihilar cholangiocarcinoma patients undergoing radical resection should ideally have at least 4 lymph nodes harvested to be accurately staged. In addition, although LODDS performed better at determining prognosis among patients with ",

author = "Fabio Bagante and Thuy Tran and Gaya Spolverato and Andrea Ruzzenente and Stefan Buttner and Ethun, {Cecilia G.} and Koerkamp, {Bas Groot} and Simone Conci and Kamran Idrees and Isom, {Chelsea A.} and Fields, {Ryan C.} and Bradley Krasnick and Weber, {Sharon M.} and Ahmed Salem and Martin, {Robert C G} and Charles Scoggins and Perry Shen and Mogal, {Harveshp D.} and Carl Schmidt and Eliza Beal and Ioannis Hatzaras and Gerardo Vitiello and Ijzermans, {Jan N M} and Maithel, {Shishir K.} and George Poultsides and Alfredo Guglielmi and Pawlik, {Timothy M.}",

year = "2016",

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doi = "10.1016/j.jamcollsurg.2016.02.012",

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pages = "750--759e2",

journal = "Journal of the American College of Surgeons",

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TY - JOUR

T1 - Perihilar Cholangiocarcinoma

T2 - Number of Nodes Examined and Optimal Lymph Node Prognostic Scheme

AU - Bagante, Fabio

AU - Tran, Thuy

AU - Spolverato, Gaya

AU - Ruzzenente, Andrea

AU - Buttner, Stefan

AU - Ethun, Cecilia G.

AU - Koerkamp, Bas Groot

AU - Conci, Simone

AU - Idrees, Kamran

AU - Isom, Chelsea A.

AU - Fields, Ryan C.

AU - Krasnick, Bradley

AU - Weber, Sharon M.

AU - Salem, Ahmed

AU - Martin, Robert C G

AU - Scoggins, Charles

AU - Shen, Perry

AU - Mogal, Harveshp D.

AU - Schmidt, Carl

AU - Beal, Eliza

AU - Hatzaras, Ioannis

AU - Vitiello, Gerardo

AU - Ijzermans, Jan N M

AU - Maithel, Shishir K.

AU - Poultsides, George

AU - Guglielmi, Alfredo

AU - Pawlik, Timothy M.

PY - 2016/5/1

Y1 - 2016/5/1

N2 - Background The role of routine lymphadenectomy for perihilar cholangiocarcinoma is still controversial and no study has defined the minimum number of lymph nodes examined (TNLE). We sought to assess the prognostic performance of American Joint Committee on Cancer/Union Internationale Contre le Cancer (7th edition) N stage, lymph node ratio, and log odds (LODDS; logarithm of the ratio between metastatic and nonmetastatic nodes) in patients with perihilar cholangiocarcinoma and identify the optimal TNLE to accurately stage patients. Methods A multi-institutional database was queried to identify 437 patients who underwent hepatectomy for perihilar cholangiocarcinoma between 1995 and 2014. The prognostic abilities of the lymph node staging systems were assessed using the Harrell's c-index. A Bayesian model was developed to identify the minimum TNLE. Results One hundred and fifty-eight (36.2%) patients had lymph node metastasis. Median TNLE was 3 (interquartile range, 1 to 7). The LODDS had a slightly better prognostic performance than lymph node ratio and American Joint Committee on Cancer, in particular among patients with 2, the hazard ratio for N1 patients was statistically significant and the hazard ratio for N1 patients increased from 1.51 with 4 TNLE to 2.10 with 10 TNLE. Although the 5-year overall survival of N1 patients was only slightly affected by TNLE, the 5-year overall survival of N0 patients increased significantly with TNLE. Conclusions Perihilar cholangiocarcinoma patients undergoing radical resection should ideally have at least 4 lymph nodes harvested to be accurately staged. In addition, although LODDS performed better at determining prognosis among patients with

AB - Background The role of routine lymphadenectomy for perihilar cholangiocarcinoma is still controversial and no study has defined the minimum number of lymph nodes examined (TNLE). We sought to assess the prognostic performance of American Joint Committee on Cancer/Union Internationale Contre le Cancer (7th edition) N stage, lymph node ratio, and log odds (LODDS; logarithm of the ratio between metastatic and nonmetastatic nodes) in patients with perihilar cholangiocarcinoma and identify the optimal TNLE to accurately stage patients. Methods A multi-institutional database was queried to identify 437 patients who underwent hepatectomy for perihilar cholangiocarcinoma between 1995 and 2014. The prognostic abilities of the lymph node staging systems were assessed using the Harrell's c-index. A Bayesian model was developed to identify the minimum TNLE. Results One hundred and fifty-eight (36.2%) patients had lymph node metastasis. Median TNLE was 3 (interquartile range, 1 to 7). The LODDS had a slightly better prognostic performance than lymph node ratio and American Joint Committee on Cancer, in particular among patients with 2, the hazard ratio for N1 patients was statistically significant and the hazard ratio for N1 patients increased from 1.51 with 4 TNLE to 2.10 with 10 TNLE. Although the 5-year overall survival of N1 patients was only slightly affected by TNLE, the 5-year overall survival of N0 patients increased significantly with TNLE. Conclusions Perihilar cholangiocarcinoma patients undergoing radical resection should ideally have at least 4 lymph nodes harvested to be accurately staged. In addition, although LODDS performed better at determining prognosis among patients with

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Perihilar Cholangiocarcinoma: Number of Nodes Examined and Optimal Lymph Node Prognostic Scheme

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