title: Prognostic significance of lymph node ratio after resection of peri-hilar cholangiocarcinoma.
abstract: BACKGROUND
  Lymph node (LN) metastases are a major negative prognostic factor for peri-hilar cholangiocarcinoma (PCC). Prognostic significance of the extent of LN dissection, number of metastatic LN and the lymph node ratio (LNR) are still under debate.
  
  
  OBJECTIVE
  The aims of the present study were to evaluate the prognostic value of the LN status, the total number of LNs evaluated and LNR in PCC.
  
  
  METHODS
  Between 1990 and 2008, 62 patients with PCC submitted to surgical resection with curative intent were retrospectively evaluated. Number and status of harvested LN were recorded.
  
  
  RESULTS
  In 53 patients (85.4%) regional lymphadenectomy was performed. Median number of LNs examined was 7 (range 1-25). Median survival was 41.9 months in patients with N0 compared with 22.7 months in 21 patients (39.6%) with N+ (P= 0.03). Median survival was 3, 18.5 and 29 months for patients with 0, 1-3 and >3 LN retrieved, respectively (P < 0.01). Five-year survival for patients above and below the LNR cut-off value of 0.25 was 0% and 22.5%, respectively (P= 0.03).
  
  
  CONCLUSIONS
  LN metastases are a major prognostic factor for survival after surgical resection of PCC. The number of LN harvested and LNR showed high prognostic value.
authors.affiliation: Department of Surgery, Division of General Surgery A, GB Rossi Hospital, University of Verona, Verona, Italy. alfredo.guglielmi@univr.it
authors.forename: Alfredo
authors.initials: A
authors.lastname: Guglielmi
authors.forename: Andrea
authors.initials: A
authors.lastname: Ruzzenente
authors.forename: Tommaso
authors.initials: T
authors.lastname: Campagnaro
authors.forename: Silvia
authors.initials: S
authors.lastname: Pachera
authors.forename: Simone
authors.initials: S
authors.lastname: Conci
authors.forename: Alessandro
authors.initials: A
authors.lastname: Valdegamberi
authors.forename: Marco
authors.initials: M
authors.lastname: Sandri
authors.forename: Calogero
authors.initials: C
authors.lastname: Iacono
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic / Q000473:pathology / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome