| Back ground & objective: Gallbladder cancer is one of the most common malignant tumors in the biliary tract system.Gallbladder cancer is characterized by rapid progression,high degree of malignancy and poor prognosis.Surgery is the most effective treatment for gallbladder cancer.Age,sex,invasion depth,liver invasion,bile duct invasion,hepatic duodenal ligament invasion,lymph node metastasis,distant metastasis,residual tumor,and peripheral invasion have been reported as independent risk factors for the prognosis of patients with gallbladder cancer.The relationship between negative lymph node counts and prognosis has been reported in many tumors including colon,stomach,esophagus,cervical cancer and breast cancer.However,little is known about the relationship between negative lymph node counts and prognosis in patients with gallbladder cancer.The purpose of this study was to investigate whether negative lymph node counts were an independent risk factor for postoperative patients with gallbladder cancer in the hope of providing more information on the prognosis of patients with gallbladder cancer.Methods: We select the U.S.national cancer institute,Surveillance,Epidemiology,and End Results(SEER)database,from 2010 to 2015 years in conformity with the requirements of 24651 patients with gallbladder cancer.All patients after surgery and pathologic diagnosis of gallbladder cancer.First,the negative lymph node count was used as a continuous variable for statistical analysis,analyze the best cut-off point ofnegative lymph node count.SPSS 22.0(IBM Corporation,Armonk,NY,USA)was used for statistical data analysis.The log-rank statistical method was used to conduct the patients' CSS univariate analysis,and the kaplan-meier survival analysis method was used to draw the survival curve.The chi-square test was used for the differences between groups.Cox regression model was used to analyze the prognostic factors associated with multiple factors.P<0.05 was considered statistically.Results: Through the corresponding inclusion criteria and exclusion criteria,a total of1754 patients were included in this study.We first put the negative lymph node counts as a continuous variable,carries on the single factor analysis it is concluded that the negative lymph node count is the factors affecting the prognosis of patients with gallbladder surgery(P<0.001),and then calculate different negative lymph node count GCSS,analysis found that negative lymph node count 2 is the best cutoff point(P<0.001),and then divided the patients into two groups,including negative lymph node count fewer than 2 groups,969 cases of patients,785 patients with negative lymph node count two or more 2 groups.Then,kaplan-meier survival curve was used to show that different negative lymph node counts had important prognostic effects on patients with gallbladder cancer,among which the 5-year GCSS of patients with negative lymph node counts two or more 2 group had better prognosis than those with negative lymph node counts fewer than 2 group,which were 23.1% and 40.9%,respectively(P<0.001).At last,single factor analysis showed that the patient's diagnosis age,diagnosis year,pathological type,tumor metastasis status,histological grade,tumor size,TNM stage,T stage,negative lymph node count,lymph node metastasis,and total number of lymph nodes were all factors affecting the prognosis of patients with gallbladder cancer after operation.The results of multi-factor analysis showed that diagnosis age,pathological type,tumor metastasis status,histological grade,tumor size,TNM stage,T stage,negative lymph nodes and total lymph nodes were independent prognostic factors for patients with gallbladder cancer after surgery(P<0.05).In the total population,TNM I/II,TNM ?/IV,TNM staging unknown group,without lymph node metastasis,lymph node metastasis,lymph node metastasisin unknown group,the negative lymph node count two or more group 5 years GCSS were better than negative lymph node count fewer than 2 groups(P<0.05).Conclusion: Negative lymph node count is an important independent prognostic factors for postoperative patients with gallbladder cancer.Other factors affecting the prognosis of postoperative patients with gallbladder cancer including age,pathological type,tumor metastasis,histological grade,tumor size,TNM staging,T stage,the total lymph node count.The negative lymph node count combined with other prognostic factors can provide more prognostic information for patients with postoperative gallbladder cancer. |
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