title: Impact of lymph node ratio as a valuable prognostic factor in gallbladder carcinoma, focusing on stage IIIB gallbladder carcinoma.
abstract: OBJECTIVE
  It is increasingly being recognized that the lymph node ratio (LNR) is an important prognostic factor for gallbladder carcinoma patients. The present study evaluated predictors of tumor recurrence and survival in a large, mono-institutional cohort of patients who underwent surgical resection for gallbladder carcinoma, focusing specifically on the prognostic value of lymph node (LN) status and of LNR in stage IIIB patients.
  
  
  METHODS
  Between 2004 and 2011, 123 patients who underwent R0 radical resection for gallbladder carcinoma at the Chonnam National University Hwasun Hospital were reviewed retrospectively. Patients were staged according to the American Joint Committee on Cancer 7th edition, and prognostic factors affecting disease free survival, such as age, sex, comorbidity, body mass index, presence of preoperative symptoms, perioperative blood transfusion, postoperative complications, LN dissection, tumor size, differentiation, lymph-vascular invasion, perineural invasion, T stage, presence of LN involvement, N stage, numbers of positive LNs, LNR and implementation of adjuvant chemotherapy, were statistically analyzed.
  
  
  RESULTS
  LN status was an important prognostic factor in patients undergoing curative resection for gallbladder carcinoma. The total number of LNs examined was implicated with prognosis, especially in N0 patients. LNR was a powerful predictor of disease free survival even after controlling for competing risk factors, in curative resected gallbladder cancer patients, and especially in stage IIIB patients.
  
  
  CONCLUSIONS
  LNR is confirmed as an independent prognostic factor in curative resected gallbladder cancer patients, especially in stage IIIB gallbladder carcinoma.
authors.affiliation: Department of Surgery, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Byung-Gwan
authors.initials: BG
authors.lastname: Choi
authors.forename: Choong-Young
authors.initials: CY
authors.lastname: Kim
authors.forename: Seung-Hyun
authors.initials: SH
authors.lastname: Cho
authors.forename: Hee-Joon
authors.initials: HJ
authors.lastname: Kim
authors.forename: Yang-Seok
authors.initials: YS
authors.lastname: Koh
authors.forename: Jung-Chul
authors.initials: JC
authors.lastname: Kim
authors.forename: Chol-Kyoon
authors.initials: CK
authors.lastname: Cho
authors.forename: Hyun-Jong
authors.initials: HJ
authors.lastname: Kim
authors.forename: Young-Hoe
authors.initials: YH
authors.lastname: Hur
keywords: Carcinoma; Gallbladder; Lymph node ratio; Stage IIIB