Modifications of the AJCC 8th edition staging system for intrahepatic cholangiocarcinoma and proposal for a new staging system by incorporating serum tumor markers

Abstract

Background: Several studies have noted that the discriminatory ability and stratification performance of the AJCC 8th edition staging system is not entirely satisfactory. We aimed to improve the American Joint Committee on Cancer (AJCC) 8th edition staging system for intrahepatic cholangiocarcinoma (ICC). Methods: A multicentric database from three Chinese mainland centers (n = 1601 patients) was used to modify the 8th edition staging system. This modified TNM (mTNM) staging system was then validated using the SEER database (n = 761 patients). A new TNM staging system, by incorporating serum tumor markers (TNMIS) into the mTNM staging system was then proposed. Results: The 8th edition staging system did not provide an adequate stratification of prognosis in the Chinese multicentric cohort. The mTNM staging system offered a better discriminatory capacity in the multicentric cohort than the original 8th edition. External validation in the SEER cohort showed that the mTNM staging system also had a good stratification performance. After further incorporating a serum marker stage into the mTNM staging, the TNMIS staging system was able to stratify prognosis even better. Conclusion: The proposed mTNM staging system resulted in better stratification performance and the TNMIS staging system provided even more accurate prognostic classification than the conventional TNM system.

Clinical features of sarcomatoid change in patients with intrahepatic cholangiocarcinoma and prognosis after surgical liver resection: A Propensity Score Matching analysis

“…To explore the difference in clinical features and prognosis for patients between patients with iCCA‐SC and ordinary iCCA, we collected the clinical medical data of ordinary iCCA patients who underwent curative liver resection within the same observational period as iCCA‐SC patients. Given that American Joint Committee on Cancer (AJCC) staging which was based on tumor size, tumor number, vascular invasion, lymph node (LN) metastasis, and other factors that influence prognosis, is the most commonly used stratification outcomes method for iCCA patients, we used the method of PSM analysis according to sex, age, and the 8th edition AJCC stage to randomly match patients with ordinary iCCA as a control group to patients with iCCA‐SC at a 1:4 ratio by using the “nearest neighbor” method. The flowchart of patient selection is shown in Figure .…”

The 8th Edition American Joint Committee on Cancer Staging for Hepato-pancreato-biliary Cancer: A Review and Update

“…21 Similarly, a Chinese study using a multicentric cohort found visceral peritoneum invasion not an independent risk factor and modified the 8th edition staging system by removing this factor, combining T1b into T2, and incorporating serum tumor markers (CA19-9 and CEA) into stage classification. 19 The authors claimed that their modifications had better discriminatory capacity and validated it through a SEER cohort. 19 It was not the first time to propose incorporating serum tumor markers for staging ICC.…”

“…19 The authors claimed that their modifications had better discriminatory capacity and validated it through a SEER cohort. 19 It was not the first time to propose incorporating serum tumor markers for staging ICC. 22 Likewise, tumor budding at the invasive front as a known risk factor in colorectal carcinoma has recently been investigated in ICC and other tumors of the biliary tree, [23][24][25] which may be incorporated in the future AJCC edition for ICC.…”

“…The prognostic performance of the 8th edition was overall not markedly improved over the 7th edition based on several validation studies, and potential modifications have been proposed. [17][18][19][20] Interestingly, although one study from a Korean group concluded that the new T3 did not provide good prognostic contrast, 17 a much larger study across 14 major hepatobiliary centers worldwide found the new T3 and stage III to stratify the risk of death for ICC patients. 20 On the other hand, a Japanese group found significant overlaps between T2, T3, and T4 on 5-year disease-specific survival rate, and the authors suggested modifying the size cutoff point at 2 cm for T1 (T1, size 2 cm without other factors; T2, size .2 cm without other factors), and keeping periductal infiltrating in T4 because of its prognostic significance.…”

Fibrinogen/Albumin Ratio Index is An Independent Predictor of Recurrence-Free Survival in Patients With Intrahepatic Cholangiocarcinoma Following Surgical Resection

“…One study showed that the risk of death was lower for TNM stage T3 than for stages T1b and T2 [9], while another reported comparable overall survival rates between stages T2 and T3 [10]. Based on these ndings, many researchers have called for a new system for evaluating and predicting the outcome of ICC [11,12]. Systemic in ammation plays a critical role in cancer development and progression.…”