Evaluation of the 8th edition American Joint Commission on Cancer (AJCC) staging system for patients with intrahepatic cholangiocarcinoma: A surveillance, epidemiology, and end results (SEER) analysis

Kim, Yuhree; Moris, Demetrios; Zhang, Xufeng; Bagante, Fabio; Spolverato, Gaya; Schmidt, C. Max; Dilhoff, Mary E.; Pawlik, Timothy M.

doi:10.1002/jso.24720

Cited by 94 publications

(82 citation statements)

References 32 publications

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“…Our multivariate analyses showed that, besides the maturity of FTS, tumor multiplicity, the presence of MVI, and LN metastasis were independent risk factors for survival, which were in accordance with previously established staging systems . It should be noted that tumor size failed to stratify survival in this study.…”

Section: Discussionsupporting

confidence: 90%

“…were in accordance with previously established staging systems [19,20]. It should be noted that tumor size failed to stratify survival in this study.…”

Section: © Alphamed Press 2018supporting

confidence: 88%

“…Tumor size of ICC was excluded in the 7th edition but was reconsidered in the 8th edition . Moreover, the cutoff value of tumor size in the AJCC staging system was also different from the LCSGJ staging system . In our study, tumor size was analyzed dichotomized at 2 cm, 5 cm, and as continuous variable, but none of them were identified as significant prognostic indicators for survival.…”

Section: Discussionmentioning

confidence: 78%

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Prognostic Nomogram Based on Histological Characteristics of Fibrotic Tumor Stroma in Patients Who Underwent Curative Resection for Intrahepatic Cholangiocarcinoma

Jing

Huang

et al. 2018

The Oncologist

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Background Fibrotic tumor stroma (FTS) has been implicated in cancer promotion in several neoplasms. The histological features of FTS are convenient and easily accessible in clinical routine in intrahepatic cholangiocarcinoma (ICC) specimens. The goal of this study was to explore prognostic impacts of the quantity and maturity of FTS on surgical ICC patients. Moreover, we aimed to propose an efficient prognostic nomogram for postoperative ICC patients. Materials and Methods The clinical profiles of 154 consecutive postoperative ICC patients were retrospectively analyzed. Tumor‐stroma ratio and morphological maturity of FTS were evaluated on hematoxylin and eosin‐stained tumor sections. CD3, CD8, and α‐smooth muscle actin (α‐SMA) staining were performed on corresponding tissue microarrays. The nomogram was established on variables selected by multivariate analyses and was validated in 10‐fold cross‐validation. Results Rich tumor stroma and strong α‐SMA expression were associated with poor overall survival (OS). However, in multivariate analyses, these two biomarkers failed to stratify both OS and recurrence‐free survival (RFS). Immature FTS was correlated with tumor multiplicity, advanced clinical stage, and sparser CD3 and CD8 positive tumor‐infiltrating lymphocytes (TILs) and was identified as an independent prognostic indicator for both OS and RFS. The nomogram comprising FTS maturity, tumor number, microvascular invasion, and lymph node metastasis possessed higher predictive power relative to conventional staging systems. Conclusion Immature FTS was an independent risk factor for survival and was associated with sparser CD3 and CD8 positive TILs in ICC. The prognostic nomogram integrating the maturity of FTS offers a more accurate risk stratification for postoperative ICC patients. Implications for Practice Accumulating evidence has suggested that fibrotic components in tumor microenvironment (TME) play a complicated and vital role in TME reprogramming and cancer progression. However, in clinical practice, the evaluation of fibrotic tumor stroma (FTS) is still neglected to some extent. This study's findings indicated that, in intrahepatic cholangiocarcinoma (ICC), the histological maturity of FTS is a robust prognostic indicator for patients who underwent curative resection. Moreover, prognostic nomogram constructed on the maturity of FTS possessed higher predictive power relative to the conventional tumor‐node‐metastasis staging systems. Taken together, the evaluation of FTS should be emphasized in clinical routine for more accurate prognostic prediction in postoperative ICC patients.

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Section: Discussionsupporting

confidence: 90%

“…were in accordance with previously established staging systems [19,20]. It should be noted that tumor size failed to stratify survival in this study.…”

Section: © Alphamed Press 2018supporting

confidence: 88%

Section: Discussionmentioning

confidence: 78%

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Prognostic Nomogram Based on Histological Characteristics of Fibrotic Tumor Stroma in Patients Who Underwent Curative Resection for Intrahepatic Cholangiocarcinoma

Jing

Huang

et al. 2018

The Oncologist

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“…Accurate assessment of tumor stages following surgical resection is important for predicting patient prognoses and providing adequate information to guide adjuvant treatment. To date, two high‐volume studies have aimed to validate the prognostic impact of the 8th edition of the AJCC staging system for ICC – an international study that included 14 major hepatobiliary centers and a study conducted in the USA based on the surveillance epidemiology and end result (SEER) database . These studies suggested that the prognostic power of the criteria in the 8th edition of the AJCC staging system was either partially improved or comparable with that of the 7th edition.…”

Section: Discussionmentioning

confidence: 99%

Prognostic comparison of the 7th and 8th editions of the American Joint Committee on Cancer staging system for intrahepatic cholangiocarcinoma

Kang

Hwang

Lee

et al. 2018

J Hepato Biliary Pancreat

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“…While these staging systems perform adequately, some investigators have suggested that the prognostic performance of AJCC/UICC and LCSGJ need further improvements. 10,26 While several groups have suggested refinements, no current staging schema has incorporated tumor biomarkers. The current study was important because we explicitly focused on defining the impact of CA 19-9 and CEA levels on long-term prognosis following resection of ICC.…”

Section: Discussionmentioning

confidence: 99%

Serum tumor markers enhance the predictive power of the AJCC and LCSGJ staging systems in resectable intrahepatic cholangiocarcinoma

Sasaki

Margonis

Andreatos

et al. 2018

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Evaluation of the 8th edition American Joint Commission on Cancer (AJCC) staging system for patients with intrahepatic cholangiocarcinoma: A surveillance, epidemiology, and end results (SEER) analysis

Abstract: The new AJCC 8th-edition staging system for ICC was largely comparable to the 7th-edition version and did not provide a marked improvement in overall prognostic discrimination.

Cited by 94 publications

References 32 publications

Prognostic Nomogram Based on Histological Characteristics of Fibrotic Tumor Stroma in Patients Who Underwent Curative Resection for Intrahepatic Cholangiocarcinoma

Prognostic Nomogram Based on Histological Characteristics of Fibrotic Tumor Stroma in Patients Who Underwent Curative Resection for Intrahepatic Cholangiocarcinoma

Prognostic comparison of the 7th and 8th editions of the American Joint Committee on Cancer staging system for intrahepatic cholangiocarcinoma

Serum tumor markers enhance the predictive power of the AJCC and LCSGJ staging systems in resectable intrahepatic cholangiocarcinoma

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