Lymph node recurrence of gallbladder carcinoma successfully managed by systemic chemotherapy with 5-fluorouracil and mitomycin C: report of a 5-year survivor

Clinical significance of lymph node micrometastasis in gallbladder carcinoma

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.

Immunohistochemical detection of lymph node micrometastases from gallbladder carcinoma using monoclonal anticytokeratin antibody

BACKGROUND

The objective of this study was to define the sensitivity and clinical implications of the immunohistochemical detection of lymph node micrometastases in patients with gallbladder carcinoma (GBC).

METHODS

The authors examined a total of 385 regional lymph nodes taken from 26 consecutive patients with GBC who had undergone a radical resection. Histologic sections of the primary tumor and regional lymph nodes in each case were stained with both hematoxylin and eosin and an antibody against cytokeratins 8 and 18 (CAM5.2). A "micrometastasis" was defined as a metastasis missed on routine histologic examination with hematoxylin and eosin but detected by immunohistochemical examination with CAM5.2. Survival rates were calculated only in patients with Stage II or more advanced stage disease.

RESULTS

All primary tumors were positive for CAM5.2. Routine histologic examination revealed 53 positive lymph nodes that were stained consistently with CAM5.2. Another seven lymph nodes had micrometastases. Patients with micrometastases showed a significantly worse survival rate than those without micrometastases (P = 0.037, log rank test). Among patients with no lymph node disease on routine histologic examination, there was a trend toward a worse survival rate in those with lymph node micrometastases (P = 0.10, log rank test). The paraaortic lymph nodes were involved more frequently in patients with lymph node micrometastases than those without (P = 0.009, Fisher exact test).

CONCLUSIONS

The immunohistochemical detection of lymph node micrometastases using CAM5.2 is feasible in GBC patients and is useful in predicting survival in patients undergoing radical resection. Lymph node micrometastases may be an indicator of widespread lymph node disease in patients with GBC.