Comparable impact of lymph node metastases in T2 gallbladder cancer on postoperative prognosis irrespective of the extent of the metastases: A retrospective analysis.

BACKGROUND

Lymph node metastases beyond the hepatoduodenal ligament are sometimes encountered in locally limited T2 gallbladder cancer (GBCA). However, the incidence and impact on prognosis remain unclear.

METHODS

This was a retrospective multi-institutional study of patients who underwent surgical resection for GBCA from 2002 to 2022. The eighth edition of the Union for International Cancer Control staging was used for tumor-node-metastasis categorization. The lymph node location was classified as follows: (A) along the hepatoduodenal ligament and common hepatic artery; (B) posterior side of the pancreatic head; and (C) others. Metastasis to regions A, B, and C nodes was denoted as Na, Nb, and Nc, respectively.

RESULTS

Data for 379 patients (pT1, 29; pT2, 162: pT3, 141; and pT4, 47) were evaluated; none with pT1 GBCA had node metastasis. For N1/2 GBCA, the proportion of patients with N2 disease increased with increasing T grade (p = .001), while the proportions of patients with Na, Nb, and Nc disease were comparable between pT2 (61%, 26%, and 13%), pT3 (63%, 26%, and 12%), and pT4 (50%, 38%, and 12%) disease (p = .681), respectively. Overall survival for pT2N1/2 disease (5 years, 43.8%) was comparable to that for pT3/4N0 disease (5 years, 37.2%; p = .192). Among patients with node-positive pT2 disease, overall survival was comparable for Na, Nb, and Nc disease, with 5-year survivals of 46%, 43%, and 31%, respectively (p = .346).

CONCLUSION

Region B or C node metastasis was not rare even in pT2 GBCA. Regarding survival outcomes, pT2 node-positive GBCA should be considered advanced disease irrespective of the extent of node metastasis.