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Prognostic impact of the number of metastatic lymph nodes in distal bile duct cancer: An analysis of Japanese registration cases by the study group for biliary surgery of the Japanese Society of Hepato‐Biliary‐Pancreatic Surgery
Author(s) -
Ishihara Shin,
Horiguchi Akihiko,
Endo Itaru,
Wakaki Toshifumi,
Hirano Satoshi,
Yamaue Hiroki,
Yamamoto Masakazu
Publication year - 2020
Publication title -
journal of hepato‐biliary‐pancreatic sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 1868-6974
DOI - 10.1002/jhbp.730
Subject(s) - medicine , lymph , lymph node , bile duct cancer , univariate analysis , proportional hazards model , bile duct , metastasis , multivariate analysis , biliary tract , cancer , oncology , radiology , pathology
Background Lymph node metastasis is an important prognostic factor for distal bile duct cancer. The number of lymph node metastases was adopted for nodal classification. However, different cutoff values have been proposed, ranging from two to five. Methods A total of 1748 cases who underwent curative surgery with pancreatoduodenectomy for distal bile duct cancer registered in the nationwide biliary tract cancer registry in Japan from 2008 to 2013 were included. Univariate Cox regression was performed to assess the effect of prognostic lymph node metastasis counts on mortality and to determine cutoff values. Results The overall survival rate after resection was 47.4% at 5 years. Univariate and multivariate analysis found prognostic factors to include lymph node metastasis. The cutoff point was set to two lymph node metastases using the Cox model. There were significant differences in pairwise comparisons between three groups by the number of metastatic lymph node ( P < .001 for 0 vs 1‐2 and P = .003 for 1–2 vs ≥3). Conclusion Our data suggest lymph node classification as N0 (patients without lymph node metastases), N1 (metastasis in 1–2 regional lymph nodes), and N2 (metastases in ≥3 regional lymph nodes).