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

Abstract

Background: Several changes have been made to the primary tumor (T) and lymph node (N) categories in the new 8 th edition of the American Joint Committee on Cancer (AJCC) staging system for perihilar cholangiocarcinoma (pCCA). This study was conducted to validate the 8 th edition of the AJCC staging system for pCCA in China. Methods: A total of 335 patients who underwent curative-intent resection for pCCA between January 2010 and December 2018 were retrospectively enrolled. The overall survival (OS) of groups of patients was calculated using the Kaplan-Meier method. The log-rank test was used to compare OS between groups. The concordance index (C-index), Akaike information criteria (AIC), and time-dependent area under receiver operating characteristic (ROC) curve (AUC) were computed to evaluate the discriminatory power of the 8 th and 7 th editions of the AJCC staging system. Results: The T category changed in 25 (7.5%) patients, the N category changed in 39 (11.6%) patients, and the tumor-node-metastasis (TNM) stage changed in 157 (46.9%) patients when the 8 th and 7 th editions were compared. No statistically significant difference in survival was observed between T2aN0M0 and T2bN0M0. The C-index of the 8 th edition was 0.609 [95% confidence interval (CI): 0.568-0.650], which was slightly higher than that of the 7 th edition (C-index, 0.599, 95% CI: 0.558-0.640). The time-dependent AUC value also corroborated that the 8 th edition had a better performance than the 7 th edition. Conclusions: The 8 th edition of the AJCC staging system for pCCA showed a better ability than the 7 th edition to discriminate patient survival. However, further simplification of the 8 th edition is still needed.

Impact of Positive Lymph Nodes and Resection Margin Status on the Overall Survival of Patients with Resected Perihilar Cholangiocarcinoma: The ENSCCA Registry

“…The updated AJCC guidelines (8th edition, 2017) distinguish between the number (n ≤ 3 or n > 3) instead of the location of regional positive lymph nodes [13,14]. Several studies investigated the value of this new staging system and found a slightly improved prognostic predictability, implying that the amount of involved lymph nodes is more predictive for survival outcome than their location [15][16][17].…”

Clinical analysis of metastatic characteristics of infrapyloric lymph nodes (No.206) and terminal ileum lymph nodes in patients with right colon cancer

“…The statistics and labeling of the colorectal lymph nodes and the classification of ileocecal group, ascending colon group, and hepatic flexure group were carried out in accordance with the 9th edition of the Japanese Society for Cancer of the Colon and Rectum guidelines [ 5 ]. The tumor infiltration depth (T stage) is classified according to the American Joint Committee on cancer (AJCC) method [ 14 ]. Endoscopic treatment was used for tumor staging under necessary conditions.…”