Evaluation of the New American Joint Committee on cancer staging manual 8th edition for perihilar cholangiocarcinoma

Abstract

Background: Distal cholangiocarcinoma has a poor prognosis. Published cohorts focusing on distal cholangiocarcinoma, especially from Western countries, are lacking. This study investigated treatment, outcome and predictors for survival in a nationwide cohort of patients with distal cholangiocarcinoma. Methods: A population-based cohort derived from the Netherlands Cancer Registry (NCR) was studied. Patients with pathologically confirmed distal cholangiocarcinoma, resected (2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015) and non-resected (2009-2015), were included. Survival was analyzed using Kaplan Meier methods and multivariable Cox analysis using backward selection. Results: A total of 794 patients was identified; 513 resected patients and 321 non-resected patients. Of the resected patients (7.8%) received (neo-)adjuvant treatment. Of 321 non-resected patients, 147 (45.8%) presented with M1 disease and 63 (19.6%) received palliative chemotherapy. Median overall survival for resected, non-resected M0, and non-resected M1 disease was 23 months (95% CI 21-26), 6 months (95% CI 5-8) and 4 months (95% CI 4-5) (p< 0.001), respectively. In multivariable analysis, T3/T4 stage (p=0.006), higher lymph node ratio (p< 0.001), poor differentiation (p=0.001) and R1 resection (p=0.002) were negative prognostic factors in resected patients. In nonresected patients, increasing age (p=0.007), lymph node metastases (p=0.013), distant metastases (p< 0.001), no surgical exploration (p=0.011) and no palliative chemotherapy (p< 0.001) predicted worse survival. Discussion: This nationwide, Western study includes the largest population with all stages of distal cholangiocarcinoma. The study identified predictors for survival in both the resected and non-resected population which can be useful to stratify future trials with (neo-) adjuvant or palliative treatment.

LINC00857 promotes cell proliferation and migration in colorectal cancer by interacting with YTHDC1 and stabilizing SLC7A5

“…The histological grade was assessed according to World Health Organization criteria (23). Tumors were staged according to the tumor-node-metastasis staging system of the American Joint Committee on Cancer (7th edition) (24). All patients provided written informed consent and the study was approved by the Ethics Committee of the Chenzhou No.…”

External validation study of the 8th edition of the American Joint Committee on Cancer staging system for perihilar cholangiocarcinoma: a single-center experience in China and proposal for simplification

“…Similarly, Ruzzenente et al (22) demonstrated that the C-index of the 8 th edition was higher than that of the 7 th edition (0.624 vs. 0.619), and this result was confirmed by a South Korean study (C-index, 0.621 vs. 0.582) (23). Furthermore, another study from The Netherlands also demonstrated that the prognostic accuracy of the 8 th edition was higher than that of the 7 th edition (C-index, 0.67 vs. 0.65) in patients who underwent curativeintent resection (24). Thus, the new classification of the AJCC TNM staging system is more reasonable than the 7 th edition, despite its poor ability to predict prognosis (C-index <0.7).…”

“…The new AJCC staging system (8 th edition) for pCCA has been tested in a few centers (22)(23)(24). However, so far, no research has been conducted in China, where the incidence of pCCA is high.…”

Surgical management of hilar cholangiocarcinoma: Controversies and recommendations

“…Instead, N2 disease (stage IVa) is now classified as 4 or more positive regional lymph nodes. Gaspersz et al [11] have compared the prognostic accuracy of the 7th and 8th editions, and concluded that though the prognostic accuracy was similar in the majority, it was poor for patients who did not undergo resection. So, they recommended that cross-sectional imaging should be used to assess the staging, instead of only resection.…”