Published online Jan 7, 2014. doi: 10.3748/wjg.v20.i1.290
Revised: October 29, 2013
Accepted: November 12, 2013
Published online: January 7, 2014
Processing time: 115 Days and 22.8 Hours
AIM: To explore risk factors of lymphatic metastasis (LM) in gallbladder cancer, and their potential to complement unsatisfactory radiological detection.
METHODS: Radiological detection of LM by computed tomography (CT) was reported to fail in more than 60% of patients with pathological LM. In order to find risk factors highly suggestive of LM other than radiological manifestations, the documents of 63 patients were analyzed statistically. Except for 4 patients having T1a disease, in whom cholecystectomy is enough for radical resection, 59 patients underwent lymphadenectomy with at least 3 lymph nodes dissected. Fifty point eight percent (32/63) of patients were found to have LM during pathological examination. The median number of dissected lymph nodes was 6 (range 3-20).
RESULTS: Only 31.3% (10/32) of patients with LM were detected by CT. Through multivariate analysis, two risk factors of LM were discovered as age < 60 years (OR = 6.24; P < 0.01) and carbohydrate antigen (CA) 19-9 elevation (OR = 5.70; P < 0.05). By analysis of patients with pathological LM but failed to be detected by CT, 81.8% (18/22) of patients had at least one risk factor, including 31.3% (10/32) who had the risk factor of age < 60 years, and 37.5% (12/32) who had the risk factor of CA 19-9 elevation. Besides, among patients with LM (n = 32), those whose age were younger than 60 years (OR = 3.41; P < 0.05) were more likely to have 3 or more positive lymph nodes.
CONCLUSION: Age < 60 years and CA 19-9 elevation could complement radiological detection of LM. Patients aged < 60 years are at higher risk of multiple positive nodes.
Core tip: High-quality lymphadenectomy is an essential part of radical resection of gallbladder cancer. However, until now, no frequently used radiological modalities could satisfy the need of precise preoperative evaluation of lymphatic status, including ultrasonography, computed tomography (CT), magnetic resonance and positron emission tomography, and most patients with lymphatic metastasis (LM) could not be detected until postoperative pathology. This study discovered two risk factors of LM as age < 60 years and carbohydrate antigen 19-9 elevation. By combining these two factors to direct radiological detection of LM on CT, the total percentage of LM detected preoperatively could have a drastic increase from 31.3% to 81.8%.