Abstract
Background
Prognosis of gallbladder cancer (GBC) is grim even after curative surgery. Lymph node metastasis is the most important prognostic factor, but distant relapses occurring in their absence point towards additional factor. Lymph node micrometastasis could be one. The present study aimed to evaluate the incidence and clinical significance of lymph node micrometastasis.
Methods
This is a prospective study of patients undergoing curative surgery for GBC from 1 March 2013 to 30 April 2015, at our institute. All lymph nodes were examined with hematoxylin and eosin and immunohistochemistry against CK7. The incidence of lymph node and its relation to other clinicopathological parameters, recurrence, and survival was evaluated.
Results
Out of 589 lymph nodes retrieved from 40 patients, metastasis was seen in 13 (2.20%) nodes from 8 (20%) patients and micrometastasis in 4 (0.68%) nodes from 3 (7.5%) patients. Micrometastases were absent in pT1 tumors (0/10 in pT1 vs. 3/30 in pT2–4) and more common in patients with nodal metastasis (13% vs. 6%). Though the presence of micrometastasis would have upstaged the disease, it did not statistically relate to clinicopathological parameters, recurrence, and survival.
Conclusions
Incidence of lymph node micrometastasis in GBC was low and did not correlate with other clinicopathological parameters, recurrence, and survival.
Similar content being viewed by others
References
Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA Cancer J Clin. 2010;60:277–300.
Miura F, Asano T, Amano H, et al. New prognostic factor influencing long-term survival of patients with advanced gallbladder carcinoma. Surgery. 2010;148:271–7.
Sasaki E, Nagino M, Ebata T, et al. Immunohistochemically demonstrated lymph node micrometastasis and prognosis in patients with gallbladder carcinoma. Ann Surg. 2006;244:99–105.
Jarnagin WR, William R, Ruo L, et al. Patterns of initial disease recurrence after resection of gallbladder carcinoma and hilar cholangiocarcinoma: implications for adjuvant therapeutic strategies. Cancer. 2003;98:1689–700.
Nagakura S, Shirai Y, Yokoyama N, Hatakeyama K. Clinical significance of lymph node micrometastasis in gallbladder carcinoma. Surgery. 2001;129:704–13.
McGuckin M, Cummings M, Walsh M, Hohn B, Bennett J, Wright R. Occult axillary node metastasis in breast cancer: their detection and prognostic significance. Br J Cancer. 1996;73:88–95.
Ishida K, Katsuyama T, Sugiyama A, Kawasaki S. Immunohistochemical evaluation of micrometastasis from gastric carcinomas. Cancer. 1997;79:1069–76.
Greenson J, Isenhart M, Rice R, Mojzisik C, Houchens D, Martin E. Identification of occult micrometastasis in pericolic lymph nodes of Dukes’ B colorectal cancer patients using monoclonal antibodies against cytokeratin and CC49. Cancer. 1994;73:563–8.
Sasaki M, Watanabe H, Jass J, Ajioka Y, Kobayashi M, Hatakeyama K. Immunoperoxidase staining for cytokeratins 8 and 18 is very sensitive for detection of occult node metastasis of colorectal cancer: a comparison with genetic analysis of K-ras. Histopathology. 1998;32:199–208.
Sasaki M, Watanabe H, Jass J, Ajioka Y, Kobayashi M, Hatakeyama K. Occult lymph node metastases detected by cytokeratin immunohistochemistry predict recurrence in “node-negative” colorectal cancer. J Gastroenterol. 1997;32:758–64.
Battifora H. Recent progress in the immunohistochemistry of solid tumors. Semin Diagn Pathol. 1984;1:251–71.
Debus E, Moll R, Franke WW, Weber K, Osborn M. Immunohistochemical distinction of human carcinomas by cytokeratin typing with monoclonal antibodies. Am J Pathol. 1984;14:121–30.
Moll R, Franke WW, Schiller DL, Geiger B, Krepler R. The catalog of human cytokeratins: patterns of expression in normal epithelia, tumors and cultured cells. Cell. 1982;31:11–24.
Copper D, Schermer A, Sun T. Classification of human epithelia and their neoplasms using monoclonal antibodies to keratin: strategies, applications and limitations. Lab Investig. 1985;52:243–56.
Tajima Y, Tomioka T, Ikematsu Y, Ichinose K, Inoue K, Kanematsu T. Immunohistochemical demonstration of cytokeratin is useful for detecting micrometastasis foci from gall bladder carcinoma in regional lymph nodes. Jpn J Clin Oncol. 1999;29:425–8.
Tanabe M, Endo I, Masunari H, et al. Is lymph-node micrometastasis in gallbladder cancer a significant prognostic factor? Hepatogastroenterology. 2012;59:31–5.
Taniguchi K, Tabata M, Iida T, Hori T, Yagi S, Uemoto S. Significance of lymph node micrometastasis in pN0 hilar bile duct carcinoma. Eur J Surg Oncol. 2006;32:208–12.
Tojima Y, Nagino M, Ebata T, Uesaka K, Kamiya J, Nimura Y. Immunohistochemically demonstrated lymph node micrometastasis and prognosis in patients with otherwise node-negative hilar cholangiocarcinoma. Ann Surg. 2003;237:201–7.
Ishida K, Katsuyama T, Sugiyama A, Kawasaki S. Immunohistochemical evaluation of lymph node micrometastases from gastric carcinomas. Cancer. 1997;79:1069–76.
Maehara Y, Oshiro T, Endo K, et al. Clinical significance of occult micrometastasis in lymph nodes from patients with early gastric cancer who died of recurrence. Surgery. 1996;119:397–402.
Greenson JK, Isenhart CE, Rice R, Mojzisik C, Houchens D, Martin EW Jr. Identification of occult micrometastases in pericolic lymph nodes of Dukes’ B colorectal cancer patients using monoclonal antibodies against cytokeratin and CC49. Correlation with long-term survival. Cancer. 1994;73:563–9.
Yokoyama N, Shirai Y, Hatakeyama K. Immunohistochemical detection of lymph node micrometastasis from gall bladder carcinoma using monoclonal anticytokeratin antibody. Cancer. 1999;85:1465–9.
Krag DN, Anderson SJ, Julian TB, et al. Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial. Lancet Oncol. 2010;11:927–33.
Liefers GJ, Cleton-Jansen AM, van de Velde CJ, et al. Micrometastases and survival in stage II colorectal cancer. N Engl J Med. 1998;339:223–38.
Koenig AM, Prenzel KL, Bogoevski D, et al. Strong impact of micrometastatic tumor cell load in patients with esophageal carcinoma. Ann Surg Oncol. 2009;16:454–62.
Ishigami S, Natsugoe S, Tokuda K, et al. Clinical impact of micrometastasis of the lymph node in gastric cancer. Am Surg. 2003;69:573–7.
Yonemori A, Kondo S, Matsuno Y, et al. Prognostic impact of regional lymph node micrometastasis in patients with node-negative biliary cancer. Ann Surg. 2010;252:99–106.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
SHS, NG, GG, AM, and SS declare that they have no competing interests.
Ethics statement
The study was performed in a manner to confirm with the Helsinki Declaration of 1975, as revised in 2000 and 2008, concerning human and animal rights, and the authors followed the policy concerning informed consent as shown on Springer.com.
Rights and permissions
About this article
Cite this article
Shah, S.H., Gupta, N., Gupta, G. et al. Lymph node micrometastasis in gallbladder cancer. Indian J Gastroenterol 36, 268–274 (2017). https://doi.org/10.1007/s12664-017-0775-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12664-017-0775-z