A Proposed Staging System for Intrahepatic Cholangiocarcinoma

Abstract

The American Joint Committee on Cancer (AJCC)/International Union Against Cancer (UICC) staging system for liver cancer is based on data exclusively derived from hepatocellular carcinoma (HCC) patients and thus may be inappropriate for patients with intrahepatic cholangiocarcinoma (ICC). We sought to empirically derive an ICC staging system from population-based data on patients with ICC. The Surveillance, Epidemiology, and End Results (SEER) database was used to identify 598 patients who underwent surgery for ICC between 1988 and 2004. The discriminative abilities of the AJCC/UICC liver cancer and two Japanese ICC staging systems were evaluated. Independent predictors of survival were identified using Cox proportional hazards models. A staging system for ICC was then derived based on these analyses. The AJCC/UICC T classification system failed to adequately stratify the T2 and T3 cohorts due to tumor size >5 cm not being a relevant prognostic factor [hazard ratio (HR) 0.97, 95% confidence interval (CI) 0.72-1.30]. In contrast, presence of multiple lesions (HR 1.42, 95% CI 1.01-2.01) or vascular invasion (HR 1.53, 95% CI 1.10-2.12) predicted adverse prognosis. Based on these findings, an ICC staging system was developed that omits tumor size. This system showed no loss of prognostic discrimination compared with the AJCC/UICC system and significant superiority over the Japanese systems. We conclude that the AJCC/UICC liver cancer staging system fails to stratify ICC patients adequately and inappropriately includes tumor size. We propose a staging system specifically developed for ICC based on number of tumors, vascular invasion, lymph node status, and presence of metastatic disease.

AJCC 7th edition of TNM staging accurately discriminates outcomes of patients with resectable intrahepatic cholangiocarcinoma

“…19 It is largely based on an analysis of data extracted from the Surveillance, Epidemiology and End Results (SEER) program on 598 patients who had undergone cancer-directed surgery for IHCC. 18 These patients were found to be inaccurately differentiated by the 6th edition of the AJCC as well as by both Japanese systems. In particular, a monotonicity of gradients was not observed.…”

“…16 Although largely validated worldwide for HCC, 17 it has proven reliable when applied to patients with IHCC. 9,18 Therefore, the 7th edition of the AJCC staging manual, which takes effect this year, has for the first time proposed a novel staging specific to IHCC. 19 It is largely based on an analysis of data extracted from the Surveillance, Epidemiology and End Results (SEER) program on 598 patients who had undergone cancer-directed surgery for IHCC.…”

“…In particular, a monotonicity of gradients was not observed. 9,18 Therefore, the data on these patients were used to construct a new model that is largely mirrored in this 7th edition.…”

Inhibition of active autophagy induces apoptosis and increases chemosensitivity in cholangiocarcinoma

“…1 ICC accounts for 5-30% of all primary liver malignancies, and its incidence has been increasing over the last several decades. 2 The mortality from intrahepatic cholangiocarcinoma is very high, with the 5-year survival rates being o15-20% in most series. 3,4 However, the exact molecular mechanisms of biliary epithelium malignant transformation are not well understood.…”

Comprehensive management of cholangiocarcinoma: Part I. Diagnosis

“…15 In 2010, the 7th edition of the American Joint Committee on Cancer (AJCC 7th) issued a new staging system for ICC based on data from the Surveillance, Epidemiology and End Results (SEER) program on almost 600 patients, who had undergone surgical resection. 14,22 Analysis included 15-year resection data out of 12 tertiary hepatobiliary centers with 168 R0 (no residual tumor) patients. Analysis of data demonstrated that N0M0 patients had 1-year and 5-year median survival rate of almost 90% and 44% respectively.…”