Abstract
Background. This retrospective study was intended to define the clinical significance of lymph
node micrometastasis in gallbladder carcinoma. Methods. A total of 1136 regional lymph nodes taken from 63 consecutive patients undergoing
radical resection were examined histologically. Micrometastasis was defined as a metastasis
missed on routine histologic examination with hematoxylin-and-eosin but detected by
immunohistochemical examination with an antibody against cytokeratins 8 and 18. Results. None of 9 patients (0%) with pT1 disease and 19 of 54 patients (35%) with pT2-4 disease
had nodal micrometastases. Univariate analysis identified nodal micrometastasis, type
of radical resection, M classification, pT classification, perineural invasion, pTNM
stage, timing of radical resection, lymphatic vessel invasion, and pN classification
as significant variables. Multivariate analysis revealed that nodal micrometastasis
(P =.0003) and type of radical resection (P=.0044) were independent prognostic factors. Nodal micrometastasis affected survival
adversely, despite the absence (P=.0002) or presence (P <.0001) of overt nodal metastasis. Nodal micrometastasis correlated significantly
with invasive characteristics: lymphatic vessel invasion, perineural invasion, and
distant metastasis. Conclusions. Lymph node micrometastasis is the strongest independent predictor of worse survival
regardless of the overt nodal status and may indicate aggressive tumor biology among
patients undergoing curative resection for gallbladder carcinoma. (Surgery 2001;129:704-13.)
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Article info
Publication history
Accepted:
January 27,
2001
Footnotes
*Supported by a grant-in-aid for scientific research (C) (no. 11671213) from the Ministry of Education, Science, Sports, and Culture of Japan.
**Reprint requests: Yoshio Shirai, MD, Department of Surgery, Niigata University School of Medicine, 1-757 Asahimachi-dori, Niigata City, 951-8510 Japan.
★Surgery 2001;129:704-13
Identification
Copyright
© 2001 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
