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. 2015 Mar 11:13:99.
doi: 10.1186/s12957-015-0526-5.

A modified Jarnagin-Blumgart classification better predicts survival for resectable hilar cholangiocarcinoma

Guoping Ding  1 , Yifei Yang  2 , Liping Cao  3 , Wenchao Chen  4 , Zhengrong Wu  5 , Guixing Jiang  6
Affiliations

A modified Jarnagin-Blumgart classification better predicts survival for resectable hilar cholangiocarcinoma

Guoping Ding et al. World J Surg Oncol. .

Abstract

Background: Prediction of postoperative survival for hilar cholangiocarcinoma (HCCA) remains difficult although there have been a variety of clinical classification and staging systems. This study was designed to validate and compare some of the major HCCA staging systems in use today. In addition, we sought to build up a new staging system modified from Jarnagin-Blumgart (J-B) classification for HCCA, to predict survival better.

Methods: A total of 154 consecutive cases of HCCA including 95 surgical patients between 2005 and 2014 were enrolled in this study. The clinical and pathological data were recorded retrospectively and three commonly used classification methods: Bismuth-Corlette (B-C) classification, TNM staging, and J-B classification were performed to analyze the correlations with resectability and survival. Chi-square test, Kaplan-Meier analysis, and kappa statistics were used to compare and confirm the relationships between the variables and survival.

Results: For all 154 patients, the resection rate of J-B T1 was 68.6% (48/70), higher than that of J-B T2 (44.8%, P = 0.007). J-B T2 also showed a higher resectability than J-B T3 (19.2%, P = 0.025). There was no significant difference in resectability within the groups B-C type and TNM stages. We set up a new staging system based on J-B classification, tumor differentiation, distant metastasis (N2 or M1 of TNM stage), and resection integrality. The total survival predictive accuracy was 69.5% (kappa = 0.547), higher than that of TNM staging and J-B classification.

Conclusions: J-B classification was more useful than B-C classification, while its value for predicting survival did not exceed TNM staging system. The new staging system, based on J-B classification, provides a better method to stratify HCCA patients during the operation.

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Figures

Figure 1
Figure 1
Survival curve of 95 HCCA patients after surgical treatment. The median survival time for all the 95 HCCA patients was 21.5 months. The 1-, 3-, and 5-year survival rates were 72%, 26%, and 21%, respectively.
Figure 2
Figure 2
Overall Kaplan-Meier survival stratified by Bismuth-Corlette classification for HCCA. The median survival times were 27, 31, 21, and 14 months for B-C I, II, III, and IV types, respectively.
Figure 3
Figure 3
Overall Kaplan-Meier survival stratified by TNM stage for HCCA. The median survival times were 35, 21, 18, and 8 months for TNM I, II, III, IV stages, respectively.
Figure 4
Figure 4
Overall Kaplan-Meier survival stratified by Jarnagin-Blumgart classification for HCCA. The median survival times were 27, 21, and 9 months for J-B T1, T2, and T3 stages, respectively.
Figure 5
Figure 5
Overall Kaplan-Meier survival stratified by the new staging system for HCCA. By this staging system, the median survival times were 41, 27, and 9 months for stages I, II, and III, respectively.
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References

    1. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011;61:69–90. doi: 10.3322/caac.20107. - DOI - PubMed
    1. Lau SH, Lau WY. Current therapy of hilar cholangiocarcinoma. Hepatobiliary Pancreat Dis Int. 2012;11:12–7. doi: 10.1016/S1499-3872(11)60119-7. - DOI - PubMed
    1. Unno M, Katayose Y, Rikiyama T, Yoshida H, Yamamoto K, Morikawa T, et al. Major hepatectomy for perihilar cholangiocarcinoma. J Hepatobiliary Pancreat Sci. 2010;17:463–9. doi: 10.1007/s00534-009-0206-3. - DOI - PubMed
    1. Young AL, Prasad KR, Toogood GJ, Lodge JP. Surgical treatment of hilar cholangiocarcinoma in a new era: comparison among leading Eastern and Western centers, Leeds. J Hepatobiliary Pancreat Sci. 2010;17:497–504. doi: 10.1007/s00534-009-0203-6. - DOI - PubMed
    1. de Jong MC, Marques H, Clary BM, Bauer TW, Marsh JW, Ribero D, et al. The impact of portal vein resection on outcomes for hilar cholangiocarcinoma: a multi-institutional analysis of 305 cases. Cancer. 2012;118:4737–47. doi: 10.1002/cncr.27492. - DOI - PubMed

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