Proposal of the optimal numbers of examined and positive lymph nodes to the 8th edition of American Joint Committee on Cancer (AJCC) staging for 758 patients with distal cholangiocarcinoma

Wu, Ronghai; Zhang, Gang; Feng, Jiexiong; Zeng, Liang; Yang, Zhi‐Ming

doi:10.1371/journal.pone.0234464

Cited by 11 publications

(11 citation statements)

References 23 publications

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“…Whether age is an independent risk factor for DCC remains controversial. You et al ( 19 ) reported that age was significantly related to the prognosis of DCC, but Chen et al ( 30 ), Wu et al ( 31 ), and the results of this study reached the opposite conclusion. This may be due to the limitations of the different studies.…”

Section: Discussioncontrasting

confidence: 83%

“…Multivariate analysis also indicated that in addition to LODDS stage, tumor grade, SEER historic stage, and tumor size were also independent risk factors for DCC patients. The prognostic value of these factors has been verified in a variety of tumors, including DCCs (4,(29)(30)(31). Whether age is an independent risk factor for DCC remains controversial.…”

Section: Discussionmentioning

confidence: 99%

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A Nomogram Based on the Log Odds of Positive Lymph Nodes Predicts the Prognosis of Patients With Distal Cholangiocarcinoma After Surgery

Sun

et al. 2021

Front. Surg.

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Background: Lymph node (LN) metastasis is considered one of the most important risk factors affecting the prognosis of distal cholangiocarcinoma (DCC). This study aimed to demonstrate the superiority of log odds of positive lymph nodes (LODDS) compared with other LN stages, and to establish a novel prognostic nomogram to predict the cancer-specific survival (CSS) of DCC.Methods: From the Surveillance, Epidemiology and End Results (SEER) database, the data of 676 patients after DCC radical operation were screened, and patients were randomly divided into training (n = 474) and validation sets (n = 474). The prognostic evaluation performance of the LODDS and American Joint Commission on Cancer (AJCC) N stage and lymph node ratio (LNR) were compared using the Akaike information criteria, receiver operating characteristic area under the curve (AUC), and C-index. Multivariate Cox analysis was used to screen independent risk factors, and a LODDS-based nomogram prognostic staging model was established. The nomogram's precision was verified by C-index, calibration curves, and AUC, and the results were compared with those of the AJCC TNM staging system.Results:Compared with the other two stages of LN metastasis, LODDS was most effective in predicting CSS in patients with DCC. Multivariate analysis proved that LODDS, histologic grade, SEER historic stage, and tumor size were independent risk factors for DCC. The C-index of the nomogram, based on the above factors, in the validation set was 0.663. The 1-, 3-, and 5-y AUCs were 0.735, 0.679, and 0.745, respectively. Its good performance was also verified by calibration curves. In addition, the C-index and Kaplan-Meier analysis showed that the nomogram performed better than the AJCC TNM staging system.Conclusion:For postoperative patients with DCC, the LODDS stage yielded better prognostic efficiency than the AJCC N and LNR stages. Compared with the AJCC TNM staging system, the nomogram, based on the LODDS, demonstrated superior performance.

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Section: Discussioncontrasting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

A Nomogram Based on the Log Odds of Positive Lymph Nodes Predicts the Prognosis of Patients With Distal Cholangiocarcinoma After Surgery

Sun

et al. 2021

Front. Surg.

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“…There is a suggestion from Park et al that although DOI is useful to separate T1-3, the measurement of DOI does not need to be rigorously and stringently performed ( 31 ). Wu et al in a study of 758 patients with dCCA to examine the optimal numbers of positive lymph nodes revealed that N1 with 1–2 node-positive (1–3 for 8th AJCC) and N2 ≥ 3 nodes positive (≥4 for 8th AJCC) can significantly separate survival time of N1 and N2 better than 8th AJCC staging system ( 29 ). Other studies propose additional factors, such as a prognostic factor, to improve prognosis in dCCA.…”

Section: Discussionmentioning

confidence: 99%

“…The 7th edition showed low-performance separation of T1 vs. T2 and T2 vs. T3, and no significant difference in the 5-year survival rate, whereas the 8th edition provided a significant difference in separation of T1 vs. T2 and T2 vs. T3, leading to better prognostic predictability ( 28 ). As far as inclusion of DOI and number of lymph node metastasis is concerned, the verdict is still out ( 29 – 32 ). There has, however, been increasing studies proposing revisions of the updated 8th edition and alternative staging systems for classification ( 33 – 37 ).…”

Section: Introductionmentioning

confidence: 99%

Prognostic Significance of Growth Pattern in Predicting Outcome of Opisthorchis viverrini-Associated Distal Cholangiocarcinoma in Thailand

Kunprom

Aphivatanasiri

Sa-Ngiamwibool

et al. 2022

Front. Public Health

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Distal cholangiocarcinoma (dCCA) is a rare type of CCA in Asia, even in Opisthorchis viverrini-prevalent Northeastern Thailand. The clinical ambiguity and imprecision of diagnosis surrounding this malignancy result in high mortality due often to advanced/metastatic disease on presentation. We aim to identify a prognostic factor that can improve the performance stratification and influence the outcome of dCCA patients after curative resection. A total of 79 patients who underwent curative-intended surgery for dCCA was enrolled. Possible risk factors for survival were analyzed with log-rank test, and independent factors with Cox regression model. dCCA patients were staged and classified according to the 8th edition the American Joint Committee on Cancer (AJCC) Staging Manual. Results were then compared with the revised classification employing the prognostic factor identified from multivariate analysis. Multivariate analysis revealed that growth pattern (p < 0.01) and distant metastasis (p = 0.012) were independent factors. Growth patterns comprise intraductal (ID), periductal infiltrating (PI), mass-forming (MF), and mixed types. When dCCA patients were grouped into those having good and poor outcomes (with and without ID components, respectively). The survival outcomes significantly differed among patients with and without ID components, which was better than with the 8th AJCC staging system in our cohort. Furthermore, Chi-square test showed that patterns without ID components (PI, MF, PI + MF) correlated with lymph node and distant metastasis. Therefore, classification of dCCA patients after curative-intended surgical resection based on growth pattern provides additional beneficial information for the prediction of survival in dCCA patients.

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“…Lymph node invasion is a prognostic for overall survival in all malignancies that display lymphatic spread, however there is not a consensus regarding the number of lymph nodes that defines an adequate dissection in patients with dCCA ( Table 4 ). The AJCC has endorsed the retrieval of at least 12 nodes for adequate lymph node staging [ 57 , 58 , 73 , 74 , 75 ]. Due to the influential impact of lymph node metastasis on treatment outcome, a study by Yoshida et al recommended CW or PPW with extended lymphadenectomy, including periaortic lymph node dissection that extended from the celiac axis superiorly, to the inferior mesenteric artery inferiorly, the lateral margin of the inferior vena cava, and the medial margin of the abdominal aorta for optimal curative resection of dCCA.…”

Section: Surgical Principlesmentioning

confidence: 99%

Surgical Treatment of Distal Cholangiocarcinoma

Gorji¹,

Beal

2022

Current Oncology

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Distal cholangiocarcinoma (dCCA) is a rare malignancy arising from the epithelial cells of the distal biliary tract and has a poor prognosis. dCCA is often clinically silent and patients commonly present with locally advanced and/or distant disease. For patients identified with early stage, resectable disease, surgical resection with negative margins remains the only curative treatment strategy available. However, despite appropriate treatment and diligent surveillance, risk of recurrence remains high with nearly 50% of patients experiencing recurrence at 5 years subsequent to surgical resection; therefore, it is prudent to continue to optimize neoadjuvant and adjuvant therapies in order to reduce the risk of recurrence and improve overall survival. In this review, we discuss the clinical presentation, workup and surgical treatment of dCCA.

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Proposal of the optimal numbers of examined and positive lymph nodes to the 8th edition of American Joint Committee on Cancer (AJCC) staging for 758 patients with distal cholangiocarcinoma

Cited by 11 publications

References 23 publications

A Nomogram Based on the Log Odds of Positive Lymph Nodes Predicts the Prognosis of Patients With Distal Cholangiocarcinoma After Surgery

A Nomogram Based on the Log Odds of Positive Lymph Nodes Predicts the Prognosis of Patients With Distal Cholangiocarcinoma After Surgery

Prognostic Significance of Growth Pattern in Predicting Outcome of Opisthorchis viverrini-Associated Distal Cholangiocarcinoma in Thailand

Surgical Treatment of Distal Cholangiocarcinoma

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