Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
PLoS One. 2021 Feb 12;16(2):e0247079. doi: 10.1371/journal.pone.0247079. eCollection 2021.
Utility of the sentinel lymph node (SLN) biopsy in some malignancies has been reported, however, research on that of gallbladder cancer (GBC) is rare. The aim of this study is to investigate whether the concept of SLN is applicable to T2/3 GBC.
A total of 80 patients who underwent resection for gallbladder cancer were enrolled in this study. Patients with GBC were stratified into two groups based on the location of tumor, peritoneal-side (T2p or 3p) and hepatic-side (T2h or 3h) groups. We evaluated the relationship between cystic duct node (CDN) and downstream lymph node (LN) status. CDN was defined as a SLN in this study.
Thirty-eight patients were classified into T2, including T2p (n = 18) and T2h (n = 20), and 42 patients into T3, including T3p (n = 22) andT3h (n = 20). The incidence of LN metastasis was significantly higher in hepatic-side than peritoneal-side in both T2 and T3 (P = 0.036 and 0.009, respectively). In T2, 14 T2p had negative CDN and downstream LN, however, three T2h had negative CDN and positive downstream LNs (defined as a skipped LN metastasis) (P = 0.043). In T3, patients with skipped LN metastasis were significantly higher in T3h (n = 11) than those in T3p (n = 2) (P<0.001). There was no recurrence of the local lymph node. Disease-free survival in the T2p and T3p were significantly better than those in the T2h and T3h (P = 0.005 and 0.025, respectively).
The concept of SLN can be applicable to T2p GBC, where the downstream LNs dissection can be omitted.
已有研究报道，某些恶性肿瘤的前哨淋巴结（SLN）活检具有一定的应用价值，但是关于胆囊癌（GBC）的研究却很少。本研究旨在探讨 SLN 概念是否适用于 T2/3 期 GBC。
本研究共纳入 80 例接受胆囊癌切除术的患者。根据肿瘤位置将 GBC 患者分为两组：胆囊底部（T2p 或 3p）和胆囊颈部（T2h 或 3h）。评估胆囊管淋巴结（CDN）与下游淋巴结（LN）状态之间的关系。本研究中 CDN 定义为 SLN。
38 例患者被分为 T2 期，包括 T2p（n=18）和 T2h（n=20），42 例患者被分为 T3 期，包括 T3p（n=22）和 T3h（n=20）。T2 期和 T3 期肝侧的 LN 转移发生率明显高于胆囊底部（P=0.036 和 0.009）。在 T2 期，14 例 T2p 的 CDN 和下游 LN 均为阴性，但 3 例 T2h 的 CDN 为阴性而下游 LN 为阳性（定义为跳跃性 LN 转移）（P=0.043）。在 T3 期，T3h 跳跃性 LN 转移患者（n=11）明显多于 T3p（n=2）（P<0.001）。局部淋巴结无复发。T2p 和 T3p 的无复发生存率明显优于 T2h 和 T3h（P=0.005 和 0.025）。
SLN 概念适用于 T2p GBC，可省略下游 LN 清扫。
