Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 14, 2015; 21(14): 4255-4260
Published online Apr 14, 2015. doi: 10.3748/wjg.v21.i14.4255
Correlation between metastatic lymph node ratio and prognosis in patients with extrahepatic cholangiocarcinoma
Jian-Wei Zhang, Yun-Mian Chu, Zhong-Min Lan, Xiao-Long Tang, Ying-Tai Chen, Cheng-Feng Wang, Xu Che
Jian-Wei Zhang, Yun-Mian Chu, Zhong-Min Lan, Xiao-Long Tang, Ying-Tai Chen, Cheng-Feng Wang, Xu Che, Department of Abdominal Surgery, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Author contributions: Zhang JW and Chu YM contributed equally to this work; Che X designed the research; Chu YM, Lan ZM and Tang XL performed the research; Zhang JW contributed new reagents/analytic tools; Chen YT and Wang CF analyzed the data; Chu YM and Lan ZM wrote the paper.
Ethics approval: The study was reviewed and approved by the Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Institutional Review Board.
Informed consent: All study participants or their legal guardian provided informed written consent prior to study enrollment.
Data sharing: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Xu Che, MD, Department of Abdominal Surgery, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China. xu.che@cicams.ac.cn
Telephone: +86-10-87787120 Fax: +86-10-87787120
Received: September 30, 2014
Peer-review started: October 14, 2014
First decision: October 29, 2014
Revised: January 16, 2015
Accepted: February 11, 2015
Article in press: February 11, 2015
Published online: April 14, 2015
Processing time: 196 Days and 18.8 Hours
Abstract

AIM: To investigate the prognostic value of metastatic lymph node ratio (MLNR) in extrahepatic cholangiocarcinoma (ECC) patients undergoing radical resection.

METHODS: Seventy-eight patients with ECC were enrolled. Associations between various clinicopathologic factors and prognosis were investigated by Kaplan-Meier analyses. The Cox proportional-hazards model was used for multivariate survival analysis.

RESULTS: The overall three- and five-year survival rates were 47.26% and 23.99%, respectively. MLNR of 0, 0-0.2, 0.2-0.5, and > 0.5 corresponded to five-year survival rates of 28.59%, 21.60%, 18.84%, and 10.03%, respectively. Univariate analysis showed that degree of tumor differentiation, lymph node metastasis, MLNR, tumor-node-metastasis (TNM) stage, and margin status were closely associated with postoperative survival in ECC patients (P < 0.05). Multivariate analysis showed that MLNR and TNM stage were independent prognostic factors after pancreaticoduodenectomy (HR = 2.13, 95%CI: 1.45-3.11; P < 0.01; and HR = 1.97, 95%CI: 1.17-3.31; P = 0.01, respectively). The median survival time for MLNR > 0.5, 0.2-0.5, 0-0.2, and 0 was 15 mo, 24 mo, 23 mo, and 35.5 mo, respectively. There were statistical differences in survival time between patients with different MLNR (χ2 = 15.38; P < 0.01).

CONCLUSION: MLNR is an independent prognostic factor for ECC patients after radical resection and is useful for predicting postoperative survival.

Keywords: Cholangiocarcinoma; Metastatic lymph node; Prognosis; Surgery

Core tip: This study aims to investigate the prognostic significance of metastatic lymph node ratio in extrahepatic cholangiocarcinoma patients undergoing radical resection. Using univariate and multivariate analysis, we found that metastatic lymph node ratio was an independent prognostic factor for these patients after radical resection and is useful for predicting postoperative survival.