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. 2011 Jun;146(6):697-703.
doi: 10.1001/archsurg.2011.122.

Hilar cholangiocarcinoma: tumor depth as a predictor of outcome

Mechteld C de Jong  1 , Seung-Mo Hong, Mathew M Augustine, Michael G Goggins, Christopher L Wolfgang, Kenzo Hirose, Richard D Schulick, Michael A Choti, Robert A Anders, Timothy M Pawlik
Affiliations

Hilar cholangiocarcinoma: tumor depth as a predictor of outcome

Mechteld C de Jong et al. Arch Surg. 2011 Jun.

Abstract

Background: The American Joint Committee on Cancer staging system for hilar cholangiocarcinoma may be inaccurate because the bile duct lacks discrete tissue boundaries.

Objectives: To examine the accuracy of the American Joint Committee on Cancer staging schemes and to determine the prognostic implications of tumor depth.

Design, setting, and patients: From January 1, 1987, through December 31, 2009, there were 106 patients who underwent resection of hilar cholangiocarcinoma who had pathologic slides available for re-review.

Main outcome measures: Tumor depth and overall survival.

Results: Overall median survival was 19.9 months. The 6th and 7th editions of the T-classification criteria were unable to discriminate among T1, T2, and T3 lesions (P > .05 for all). Median survival was associated with the invasion depth of the tumor (≥5 mm vs <5 mm): 18 months vs 30 months (P = .01). On multivariate analysis, tumor depth remained predictive of disease-specific death (hazard ratio, 1.70; P = .03).

Conclusions: The American Joint Committee on Cancer T-classification criteria did not stratify patients with regard to prognosis. Depth of tumor invasion is a better predictor of long-term outcome.

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Figures

Figure 1
Figure 1
Pathologic slides (hematoxylin-eosin, original magnification ×1; images in insets are original magnification ×4) of 3 hilar cholangiocarcinomas included in the current study, illustrating the discordance between the American Joint Committee on Cancer 6th and 7th edition T-classification staging schemes and invasion depth of the tumor. A, Invasion depth of 17 mm and classified as a T2 tumor in both editions. B, A T3 tumor in the 6th edition but a T2 tumor in the 7th edition (invasion depth of 14 mm). C, A T2 tumor in the 6th edition whereas a T3 tumor in the 7th edition (maximum depth of tumor invasion, 11 mm).
Figure 2
Figure 2
Overall Kaplan-Meier survival stratified according to the American Joint Committee on Cancer 6th Edition (A) and 7th edition (B) T-classification staging scheme.
Figure 3
Figure 3
Overall Kaplan-Meier survival stratified according to the depth of tumor invasion (>5 mm vs ≥5 mm).
See this image and copyright information in PMC

References

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