title: Risk factors of lymphatic metastasis complement poor radiological detection in gallbladder cancer.
abstract: OBJECTIVE
  To explore risk factors of lymphatic metastasis (LM) in gallbladder cancer, and their potential to complement unsatisfactory radiological detection.
  
  
  METHODS
  Radiological detection of LM by computed tomography (CT) was reported to fail in more than 60% of patients with pathological LM. In order to find risk factors highly suggestive of LM other than radiological manifestations, the documents of 63 patients were analyzed statistically. Except for 4 patients having T1a disease, in whom cholecystectomy is enough for radical resection, 59 patients underwent lymphadenectomy with at least 3 lymph nodes dissected. Fifty point eight percent (32/63) of patients were found to have LM during pathological examination. The median number of dissected lymph nodes was 6 (range 3-20).
  
  
  RESULTS
  Only 31.3% (10/32) of patients with LM were detected by CT. Through multivariate analysis, two risk factors of LM were discovered as age < 60 years (OR = 6.24; P < 0.01) and carbohydrate antigen (CA) 19-9 elevation (OR = 5.70; P < 0.05). By analysis of patients with pathological LM but failed to be detected by CT, 81.8% (18/22) of patients had at least one risk factor, including 31.3% (10/32) who had the risk factor of age < 60 years, and 37.5% (12/32) who had the risk factor of CA 19-9 elevation. Besides, among patients with LM (n = 32), those whose age were younger than 60 years (OR = 3.41; P < 0.05) were more likely to have 3 or more positive lymph nodes.
  
  
  CONCLUSIONS
  Age < 60 years and CA 19-9 elevation could complement radiological detection of LM. Patients aged < 60 years are at higher risk of multiple positive nodes.
authors.affiliation: Tu-Nan Yu, Bo Shen, Ning Meng, Hong Yu, Xiu-Jun Cai, The Second Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China.
authors.forename: Tu-Nan
authors.initials: TN
authors.lastname: Yu
authors.affiliation: Tu-Nan Yu, Bo Shen, Ning Meng, Hong Yu, Xiu-Jun Cai, The Second Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Shen
authors.affiliation: Tu-Nan Yu, Bo Shen, Ning Meng, Hong Yu, Xiu-Jun Cai, The Second Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China.
authors.forename: Ning
authors.initials: N
authors.lastname: Meng
authors.affiliation: Tu-Nan Yu, Bo Shen, Ning Meng, Hong Yu, Xiu-Jun Cai, The Second Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China.
authors.forename: Hong
authors.initials: H
authors.lastname: Yu
authors.affiliation: Tu-Nan Yu, Bo Shen, Ning Meng, Hong Yu, Xiu-Jun Cai, The Second Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China.
authors.forename: Xiu-Jun
authors.initials: XJ
authors.lastname: Cai
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D018395:CA-19-9 Antigen / Q000032:analysis; D016009:Chi-Square Distribution; D002763:Cholecystectomy; D005260:Female; D005706:Gallbladder Neoplasms / Q000000981:diagnostic imaging* / Q000276:immunology / Q000556:secondary* / Q000601:surgery; D006801:Humans; D016015:Logistic Models; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000276:immunology / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D015854:Up-Regulation
chemical_list: D018395:CA-19-9 Antigen
keywords: Age; Carbohydrate antigen 19-9; Gallbladder cancer; Lymph node excision; Lymphatic metastasis; Multidetector computed tomography