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. 2019 Jan;51(1):98-111.
doi: 10.4143/crt.2017.595. Epub 2018 Mar 2.

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

Sun-Young Jun  1 , You-Na Sung  2 , Jae Hoon Lee  3 , Kwang-Min Park  3 , Young-Joo Lee  3 , Seung-Mo Hong  2
Affiliations

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

Sun-Young Jun et al. Cancer Res Treat. 2019 Jan.

Abstract

Purpose: T category of the eighth edition of the American Joint Committee on Cancer (AJCC) staging system for distal bile duct carcinoma (DBDC) was changed to include tumor invasion depth measurement, while the N category adopted a 3-tier classification system based on the number of metastatic nodes.

Materials and methods: To validate cancer staging, a total of 200 surgically resected DBDCs were staged and compared according to the seventh and eighth editions.

Results: T categories included T1 (n=37, 18.5%), T2 (n=114, 57.0%), and T3 (n=49, 24.5%). N categories included N0 (n=133, 66.5%), N1 (n=50, 25.0%), and N2 (n=17, 8.5%). Stage groupings included I (n=33, 16.5%), II (n=150, 75.0%), and III (n=17, 8.5%). The overall 5-year survival rates (5-YSRs) of T1, T2, and T3 were 59.3%, 42.4%, and 12.2%, respectively. T category could discriminate patient survival by both pairwise (T1 and T2, p=0.011; T2 and T3, p < 0.001) and overall (p < 0.001) comparisons. The overall 5-YSRs of N0, N1, and N2 were 47.3%, 17.0%, and 14.7%, respectively. N category could partly discriminate patient survival by both pairwise (N0 and N1, p < 0.001; N1 and N2, p=0.579) and overall (p < 0.001) comparisons. The overall 5-YSRs of stages I, II, and III were 59.0%, 35.4%, and 14.7%, respectively. Stages could distinguish patient survival by both pairwise (I and II, p=0.002; II and III, p=0.015) and overall (p < 0.001) comparisons. On multivariate analyses, T and N categories (p=0.014 and p=0.029) and pancreatic invasion (p=0.006) remained significant prognostic factors.

Conclusion: The T andNcategories of the eighth edition AJCC staging system for DBDC accurately predict patient prognosis.

Keywords: Bile duct; Cholangiocarcinoma; Extrahepatic; Neoplasm; Staging.

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Conflict of interest statement

Conflict of interest relevant to this article was not reported.

Figures

Fig. 1.
Fig. 1.
Schematic drawing of the distal bile duct (BD).
Fig. 2.
Fig. 2.
Overall survival stratified by T and N categories of distal bile duct carcinomas according to the American Joint Committee on Cancer. T categories of the eighth edition (A) and the seventh edition (B) and N categories of the eighth edition (C) and the seventh edition (D).
Fig. 3.
Fig. 3.
Overall survival stratified by stage group of distal bile duct carcinomas according to the American Joint Committee on Cancer eighth edition (A and B) and seventh edition stage grouping (C and D).
Fig. 4.
Fig. 4.
Overall survival stratified by size-based criteria of distal bile duct carcinomas (DBDCs). All DBDCs (A), including intra-pancreatic, extra-pancreatic, and both intra- and extra-pancreatic types. Intra-pancreatic (B) and extra-pancreatic (C) DBDCs.
Fig. 5.
Fig. 5.
Overall survival stratified by number of metastatic lymph nodes.
See this image and copyright information in PMC

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