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. 2020 Jul;24(7):1612-1618.
doi: 10.1007/s11605-019-04127-x. Epub 2019 Feb 12.

Evaluation of the New American Joint Committee on Cancer Staging Manual 8th Edition for Perihilar Cholangiocarcinoma

Marcia P Gaspersz  1 , Stefan Buettner  2 , Jeroen L A van Vugt  2 , Jeroen de Jonge  2 , Wojciech G Polak  2 , Michail Doukas  3 , Jan N M Ijzermans  2 , Bas Groot Koerkamp  4 , François E J A Willemssen  5
Affiliations

Evaluation of the New American Joint Committee on Cancer Staging Manual 8th Edition for Perihilar Cholangiocarcinoma

Marcia P Gaspersz et al. J Gastrointest Surg. 2020 Jul.

Abstract

Background: The aim was to compare the prognostic accuracy of cross-sectional imaging of the 7th and 8th editions of the American Joint Committee on Cancer(AJCC) staging system for perihilar cholangiocarcinoma(PHC).

Methods: All patients with PHC between 2002 and 2014 were included. Imaging at the time of presentation was reassessed and clinical tumor-node-metastasis (cTNM) stage was determined according to the 7th and 8th editions of the AJCC staging system. Comparison of the prognostic accuracy was performed using the concordance index (c-index).

Results: A total of 248 PHC patients were included;45 patients(18.1%) underwent a curative-intent resection, whereas 203 patients(81.9%) did not because they were unfit for surgery or were diagnosed with locally advanced or metastatic disease during workup. Prognostic accuracy was comparable between the 7th and 8th editions (c-index 0.57 vs 0.58). For patients who underwent a curative-intent resection, the prognostic accuracy of the 8th edition (0.67) was higher than the 7th (0.65). For patients who did not undergo a curative-intent resection, the prognostic accuracy was poor in both the 7th as the 8th editions (0.54 vs 0.57).

Conclusion: The 7th and 8th editions of the AJCC staging system for PHC have comparable prognostic accuracy. Prognostic accuracy was particularly poor in unresectable patients.

Keywords: Klatskin; Perihilar cholangiocarcinoma; Prognostic model; TNM stage.

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Figures

Fig. 1
Fig. 1
Flow diagram of patient cohort
Fig. 2
Fig. 2
Kaplan–Meier curves for OS for the main stages of the 7th edition
Fig. 3
Fig. 3
Kaplan–Meier curves for OS for the main stages of the 8th edition
See this image and copyright information in PMC

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