Sakata 1

SUPPLEMENTAL FIG. 1 Distribution of the number of retrieved regional lymph nodes from 148 patients with gallbladder carcinoma. The median number of retrieved regional nodes per patient was 10.5 (range, 3–33).

Sakata 1

TABLE 1 Incidence of lymph node metastasis and 5-year overall survival in patients with positive lymph nodes for each lymph node group
Node group / No. of patients with node group evaluated / No. of patients with positive nodes / Incidence of lymph node metastasis (%) / 5-year overall survival in patients with positive nodes (%) / No. of 5-year survivors with positive nodes
Regional node groupsa
Pericholedochal / 148 / 36 / 24.3 / 25.0 / 9
Cystic duct / 148 / 28 / 18.9 / 46.4 / 13
Retroportal / 148 / 21 / 14.2 / 22.2 / 4
Proper hepatic artery / 145 / 12 / 8.3 / 25.0 / 3
Common hepatic artery / 135 / 16 / 11.9 / 12.5 / 1
Other node groups
Posterior superior pancreaticoduodenal / 148 / 19 / 12.8 / 31.6 / 6
Hilar / 112 / 0 / 0 / - / -
Paraaortic / 85 / 13 / 15.3 / 15.4 / 2
Right celiac / 59 / 4 / 6.8 / 25.0 / 1
Perigastric / 51 / 3 / 5.9 / 0 / 0
Superior mesenteric / 49 / 3 / 6.1 / 0 / 0
Posterior inferior pancreaticoduodenal / 37 / 3 / 8.1 / 0 / 0
Anterior superior pancreaticoduodenal / 30 / 1 / 3.3 / 0 / 0
Anterior inferior pancreaticoduodenal / 28 / 2 / 7.1 / 0 / 0
a According to the 7th edition of the UICC TNM staging system5
TABLE 2 Multivariate analysis for overall survival in 148 patients with gallbladder carcinoma
Variable / Hazard ratio / 95% confidence interval / p value
Multivariate analysis for nodal status based on the UICC TNM staging system
pT classificationa
pT1plus pT2 / 1.000
pT3 plus pT4 / 2.771 / 1.518-5.058 / 0.001
Residual tumor classificationa
R0 / 1.000
R1 / 2.473 / 1.391-4.398 / 0.002
Perineural invasiona
Pn0 / 1.000
Pn1 / 2.148 / 1.241-3.718 / 0.006
Multivariate analysis for modified nodal statusb
pT classificationa
pT1plus pT2 / 1.000
pT3 plus pT4 / 3.169 / 1.793-5.602 / < 0.001
Residual tumor classificationa
R0 / 1.000
R1 / 2.361 / 1.337-4.172 / 0.003
Perineural invasiona
Pn0 / 1.000
Pn1 / 1.901 / 1.132-3.193 / 0.015
Modified nodal statusb
pN0M0 / 1.000
pN1M0 / 1.384 / 0.839-2.282 / 0.203
pM1(LYM) / 2.303 / 1.235-4.312 / 0.009
pT classification pathologic primary tumor classification, R0 no residual tumor, R1 microscopic residual tumor, Pn0 no perineural invasion, Pn1 perineural invasion pN classification pathological regional lymph nodes classification, pM classification pathological distant metastasis classification, LYM lymph nodes
a According to the 7th edition of the UICC TNM staging system5
b The posterior superior pancreaticoduodenal nodes were classified as regional lymph nodes
SUPPLEMENTAL TABLE 1 Radical resection procedures for 148 patients with gallbladder carcinoma
Procedure / No. of patients
Extended cholecystectomy (n = 95)
C + WR + BD + N / 52
C + WR + N / 23
Ca + BD + N / 14
Ca + N / 6
More extensive resection (n = 53)
C + H + BD + N / 25
C + WR + PD + N / 14
C + H + PD + N / 9
Ca + PD + N / 5
Combined resection of contiguous tissues
Transverse colon / 12
Portal vein / 10
Duodenum / 3
Inferior vena cava / 2
Stomach / 1
C cholecystectomy, WR wedge resection of the gallbladder fossa, BD resection of the extrahepatic bile duct, N regional lymphadenectomy, H major hepatectomy defined as removal of two sections or more, PD Whipple, pylorus-preserving, or subtotal stomach-preserving pancreaticoduodenectomy
a Cholecystectomy with full-thickness dissection
SUPPLEMENTAL TABLE 2 Postoperative morbidity in 148 patients with gallbladder carcinoma
Morbidity / No. of patients
Intraabdominal abscess / 36
Biliary fistula / 17
Wound infection / 11
Delayed gastric empty / 8
Pancreatic fistula / 7
Methicillin-resistant Staphylococcus aureus or pseudomembranous enterocolitis / 6
Liver failure / 5
Pleural effusion / 5
Intraabdominal bleeding / 4
Pneumonia / 3
Pulmonary embolism / 1
SUPPLEMENTAL TABLE 3 Adjuvant chemotherapy administered in 49 patients with gallbladder carcinoma
Regimen / No. of patients
Oral 5-fluorouracil or its derivatives / 33
Intravenous 5-fluorouracil alone or in combination with other agents / 8
Intravenous gemcitabine alone or in combination with S-1 / 8
SUPPLEMENTAL TABLE 4 Clinicopathological characteristics of 148 patients with gallbladder carcinoma
Variable / No. of patients (%)
Age (years)
≤ 70 / 94 (63.5)
> 70 / 54 (36.5)
Sex
Male / 92 (62.2)
Female / 56 (37.8)
Gallstone
Absent / 81 (54.7)
Present / 67 (45.3)
Timing of radical resection
Initial radical resection / 122 (82.4)
Radical second resection / 26 (17.6)
Type of radical resection
Extended cholecystectomya / 95 (64.2)
More extensive resectionb / 53 (35.8)
Adjuvant chemotherapy
Absent / 99 (66.9)
Present / 49 (33.1)
Size of primary tumor (mm)
≤ 60 / 84 (56.8)
> 60 / 64 (43.2)
pT classificationc
pT1 / 14 (9.5)
pT2 / 63 (42.6)
pT3 / 52 (35.1)
pT4 / 19 (12.8)
pN classificationc
pN0 / 85 (57.4)
pN1 / 63 (42.6)
pM classificationc
pM0 / 119 (80.4)
pM1 (LYM) / 29 (19.6)d
SUPPLEMENTAL TABLE 4 “Continued”
Variable / No. of patients (%)
Histological type
Adenocarcinoma / 128 (86.5)
Otherse / 20 (13.5)
Histological gradec
G1 / 54 (36.4)
G2 / 47 (31.8)
G3 plus G4 / 47 (31.8)
Lymphatic invasionc
L0 / 61 (41.2)
L1 / 87 (58.8)
Venous invasionc
V0 / 84 (56.8)
V1 / 64 (43.2)
Perineural invasionc
Pn0 / 80 (54.1)
Pn1 / 68 (45.9)
Residual tumor classificationc
R0 / 130 (87.8)
R1 / 18 (12.2)
pT classification pathologic primary tumor classification, pN classification pathological regional lymph nodes classification, pM classification pathological distant metastasis classification, LYM lymph nodes G1 well differentiated, G2 moderately differentiated, G3 poorly differentiated, G4 undifferentiated, L0 no lymphatic vessel invasion, L1 lymphatic vessel invasion, V0 no venous invasion, V1 microscopic venous invasion, Pn0 no perineural invasion, Pn1 perineural invasion, R0 no residual tumor, R1 microscopic residual tumor
a Extended cholecystectomy consisting of cholecystectomy, wedge resection of the gallbladder fossa, resection of the extrahepatic bile duct, and regional lymphadenectomy
b More extensive resections included major hepatectomy, pancreaticoduodenectomy, and major hepatectomy combined with pancreaticoduodenectomy
c According to the 7th edition of the UICC TNM staging system5
d Includes 7 with isolated distant nodal metastases
e Other histological types included adenosquamous carcinoma (n = 15), squamous carcinoma (n = 2), small cell carcinoma (n = 2), and undifferentiated carcinoma (n = 1)
SUPPLEMENTAL TABLE 5 Univariate analysis for overall survival in 148 patients with gallbladder carcinoma
Variable / No. of patients / Overall survival rate (%) / Univariate analysis
5-year / 10-year / p value
Age (years) / 0.039
≤ 70 / 94 / 57.7 / 48.7
> 70 / 54 / 42.0 / 22.8
Sex / 0.108
Male / 56 / 46.8 / 30.7
Female / 92 / 55.3 / 46.3
Gallstone / 0.201
Absent / 81 / 46.1 / 35.3
Present / 67 / 59.0 / 48.3
Timing of radical resection / 0.052
Initial radical resection / 122 / 48.6 / 37.4
Radical second resection / 26 / 68.2 / 58.9
Type of radical resection / < 0.001
Extended cholecystectomya / 95 / 66.3 / 53.5
More extensive resectionb / 53 / 26.8 / 19.7
Adjuvant chemotherapy / 0.065
Absent / 99 / 45.5 / 36.9
Present / 49 / 64.2 / 50.3
Size of primary tumor (mm) / 0.628
≤ 60 / 84 / 52.0 / 45.3
> 60 / 64 / 52.2 / 37.0
pT classificationc / < 0.001
pT1 plus pT2 / 77 / 79.9 / 67.6
pT3 plus pT4 / 71 / 21.0 / 12.7
Histological type / 0.007
Adenocarcinoma / 128 / 55.0 / 43.5
Othersd / 20 / 31.6 / 26.3
Histological gradec / 0.003
G1 / 54 / 68.9 / 54.8
G2 plus G3 plus G4 / 94 / 41.6 / 32.5
SUPPLEMENTAL TABLE 5 “Continued”
Variable / No. of patients / Overall survival rate (%) / Univariate analysis
5-year / 10-year / p value
Lymphatic invasionc / < 0.001
L0 / 61 / 72.6 / 57.7
L1 / 87 / 37.9 / 29.9
Venous invasionc / < 0.001
V0 / 84 / 63.8 / 54.2
V1 / 64 / 37.5 / 26.2
Perineural invasionc / < 0.001
Pn0 / 80 / 73.0 / 62.3
Pn1 / 68 / 27.1 / 16.3
Residual tumor classificationc / < 0.001
R0 / 130 / 0 / 0
R1 / 18 / 59.5 / 47.2
Nodal status based on the TNM staging systemc / < 0.001
pN0M0 / 78 / 67.7 / 56.1
pN1M0 / 41 / 40.7 / 26.9
pM1(LYM) / 29 / 27.6 / 23.6
Modified nodal statuse / < 0.001
pN0M0 / 78 / 67.7 / 56.1
pN1M0 / 50 / 43.5 / 31.9
pM1(LYM) / 20 / 15.0 / 10.0
pT classification pathologic primary tumor classification, G1 well differentiated, G2 moderately differentiated, G3 poorly differentiated, G4 undifferentiated, L0 no lymphatic vessel invasion, L1 lymphatic vessel invasion, V0 no venous invasion, V1 microscopic venous invasion, Pn0 no perineural invasion, Pn1 perineural invasion, R0 no residual tumor, R1 microscopic residual tumor, pN classification pathological regional lymph nodes classification, pM classification pathological distant metastasis classification, LYM lymph nodes
a Extended cholecystectomy consisting of cholecystectomy, wedge resection of the gallbladder fossa, resection of the extrahepatic bile duct, and regional lymphadenectomy
b More extensive resections included major hepatectomy, pancreaticoduodenectomy, and major hepatectomy combined with pancreaticoduodenectomy
c According to the 7th edition of the UICC TNM staging system5
d Other histological types included adenosquamous carcinoma (n = 15), squamous carcinoma (n = 2), small cell carcinoma (n = 2), and undifferentiated carcinoma (n = 1)
e The posterior superior pancreaticoduodenal nodes were classified as regional lymph nodes