Validation of the Eighth American Joint Committee on Cancer Staging System for Distal Bile Duct Carcinoma

Jun, Sun-Young; Sung, You‐Na; Lee, Jae Hoon; Park, Kwang-Min; Lee, Young‐Joo; Hong, Seung‐Mo

doi:10.4143/crt.2017.595

Cited by 28 publications

(16 citation statements)

References 14 publications

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“…TNM staging is the most widely accepted and clinically used system in determining the prognosis of cancers occurring in almost all gastrointestinal tracts. Recently, the eighth edition of the AJCC TNM classification was published, and a retrospective single center study was conducted to validate the changed staging system for DCC [7]. In the study, the application of T category defined by DOI and N category with three-tier classification showed better separation of survival curves of each prognostic group than the conventional system.…”

Section: Discussionmentioning

confidence: 99%

“…When classified by the AJCC 7th edition, 159 patients (67.7%) were classified as T3. The median TLNC and PLNC were 18 (1-64) and 2 (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17), and the median LNR values obtained by using these two values were 0.11 (0.02-1.00). In the 7th AJCC classification, 78 patients were classified as N1.…”

Section: Patient Characteristicsmentioning

confidence: 96%

“…As a result, metastases in 1-3 regional lymph nodes were classified as N1, and patients with four or more metastases as N2. Validation of this new AJCC 8th staging system was performed through a single institution retrospective study [7]. It was shown that the 8th edition can predict a patient's prognosis more accurately than the 7th edition.…”

Section: Introductionmentioning

confidence: 99%

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Proposed Modification of Staging for Distal Cholangiocarcinoma Based on the Lymph Node Ratio Using Korean Multicenter Database

You

Shin

Choi

et al. 2020

Cancers

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The 8th American Joint Committee on Cancer (AJCC) staging system for distal cholangiocarcinoma (DCC) included a positive lymph node count (PLNC), but a comparison of the prognostic predictive power of PLNC and lymph node ratio (LNR) is still under debate. This study aimed to compare various staging models made by combining the abovementioned factors, identify the model with the best predictive power, and propose a modified staging system. We retrospectively reviewed 251 patients who underwent surgery for DCC at four centers. To determine the superiority of various staging models for predicting overall OSR, Akaike information criterion (AIC), Bayesian information criterion (BIC), AIC correction (AICc), and Harrell’s C-statistic were calculated. In multivariate analysis, age (p = 0.003), total lymph node count (p = 0.033), and revised T(LNR)M staging (p < 0.001) were identified as independent factors for overall survival rate. The predictive performance of revised T (LNR) M staging (AIC: 1288.925, BIC: 1303.377, AICc: 1291.52, and Harrell’s C statics: 0.667) was superior to other staging system. A modified staging system consisting of revised T category and LNR predicted better overall survival of DCC than AJCC 7th and AJCC 8th editions. In the future, external validation of the proposed new system using a larger cohort will be required.

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Section: Discussionmentioning

confidence: 99%

Section: Patient Characteristicsmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

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Proposed Modification of Staging for Distal Cholangiocarcinoma Based on the Lymph Node Ratio Using Korean Multicenter Database

You

Shin

Choi

et al. 2020

Cancers

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“…[6][7][8][9] From the 7th edition onwards, gallbladder invasions were not considered as belonging to the T category for perihilar bile duct cancers and remained as T3 for DBDCs. 1,2 Although gallbladder invasions have traditionally been accepted as a component of the T category-related factors of DBDC, previous studies have not demonstrated the survival effects of gallbladder invasions in DBDC (Table 3). [10][11][12][13][14][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] Moreover, no single gallbladder invasion was reported in 1543 cases from 23 previous studies of DBDCs.…”

Section: Multivariate Analysismentioning

confidence: 99%

“…2020;144:755-763; doi: 10.5858/ arpa.2019-0218-OA) B ile duct carcinomas (also known as cholangiocarcinomas) comprise 3% of all gastrointestinal cancers globally. 1 Bile duct carcinomas are classified as intrahepatic or extrahepatic bile duct (EBD) carcinomas, and EBD carcinomas are further subclassified as perihilar or distal bile duct carcinomas (DBDCs). 2 It was estimated that 10,910 Americans would be diagnosed with EBD or gallbladder carcinomas in 2015.…”

mentioning

confidence: 99%

Clinicopathologic and Prognostic Significance of Gallbladder and Cystic Duct Invasion in Distal Bile Duct Carcinoma

Jun

Sung³

et al. 2019

Archives of Pathology &Amp; Laboratory Medicine

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Context.— The roles of the gallbladder and cystic duct (CD) invasions in distal bile duct carcinoma (DBDC) have not been well elucidated. Objective.— To define the characteristics and prognostic significance of gallbladder or CD invasions in patients with DBDC. Design.— Organ invasion patterns with clinicopathologic features were assessed in 258 resected DBDCs. Results.— CD invasions (N = 31) were associated with frequent concomitant pancreatic and/or duodenal invasions (23 of 31, 74%) and showed stromal infiltration (16 of 31, 52%) and intraductal cancerization (15 of 31, 48%) patterns. In only 2 cases, invasions with intraductal cancerization were observed in the gallbladder neck. Conversely, all pancreatic (N = 175) and duodenal (83) invasions developed through stromal infiltration. CD invasions were associated with larger tumor size ( P = .001), bile duct margin positivity ( P = .001), perineural invasions ( P = .04), and higher N categories ( P = .007). Patients with pancreatic or duodenal invasions had significantly lower survival rates than those without pancreatic (median, 31.0 versus 93.9 months) or duodenal (27.5 versus 56.8 months, P < .001, both) invasions. However, those with gallbladder or CD invasions did not have different survival times ( P = .13). Patients with concomitant gallbladder/CD and pancreatic/duodenal invasions demonstrated significantly lower survival rates than those without organ invasions ( P < .001). Conclusions.— Gallbladder invasions were rare in DBDCs as neck invasions with intraductal cancerization. CD invasions occurred by stromal infiltrations and intraductal cancerization, whereas all pancreatic and duodenal invasions had stromal infiltration patterns. Gallbladder and/or CD invasions did not affect survival rates of patients with DBDC, while pancreatic and duodenal invasions affected survival rates. Therefore, these differences in survival rates may originate from the different invasive patterns of DBDCs.

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Subdivision of pT1N0 (American Joint Committee on Cancer 8th edition) distal cholangiocarcinoma for adjuvant chemotherapy consideration

Otsuka,

Sugiura,

Ashida

et al. 2024

J Hepato Biliary Pancreat

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BackgroundThe adjuvant S‐1 trial affirmed adjuvant chemotherapy for biliary tract cancer but excluded pT1N0 distal cholangiocarcinoma (DCC) according to the seventh edition of the American Joint Committee on Cancer (AJCC) classification. The introduction of tumor depth of invasion (DOI) for T‐classification in the eighth edition complicates identifying DCC patients less likely to benefit from adjuvant chemotherapy.MethodsOur cohort consisted of 185 patients with DCC who underwent pancreaticoduodenectomy between 2002 and 2019. We compared clinicopathological factors and survival outcomes between pT1N0 patients in the seventh edition and those in the eighth edition. New DOI cutoffs for subdividing pT1N0 (8th edition) patients were evaluated to identify patients less likely to benefit from adjuvant chemotherapy.ResultsTransitioning to the eighth edition increased in pT1N0 cases from eight to 46. The 5‐year cumulative recurrence rates of them were 14.3% for the seventh edition and 28.3% for the eighth edition. We proposed a DOI cutoff of <2 mm, at which the 5‐year cumulative recurrence rate was 11.5%.ConclusionThe eighth AJCC classification revealed that a significant proportion of pT1N0 DCC patients were at risk for recurrence. A DOI cutoff of <2 mm may be considered to potentially improve patient selection for adjuvant chemotherapy.

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Validation of the Eighth American Joint Committee on Cancer Staging System for Distal Bile Duct Carcinoma

Abstract: The T and N categories of the eighth edition AJCC staging system for DBDC accurately predict patient prognosis.

Cited by 28 publications

References 14 publications

Proposed Modification of Staging for Distal Cholangiocarcinoma Based on the Lymph Node Ratio Using Korean Multicenter Database

Proposed Modification of Staging for Distal Cholangiocarcinoma Based on the Lymph Node Ratio Using Korean Multicenter Database

Clinicopathologic and Prognostic Significance of Gallbladder and Cystic Duct Invasion in Distal Bile Duct Carcinoma

Subdivision of pT1N0 (American Joint Committee on Cancer 8th edition) distal cholangiocarcinoma for adjuvant chemotherapy consideration

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