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Clinical Trial
. 2020 Jul;52(3):886-895.
doi: 10.4143/crt.2020.023. Epub 2020 Mar 12.

Prognostic Predictability of American Joint Committee on Cancer 8th Staging System for Perihilar Cholangiocarcinoma: Limited Improvement Compared with the 7th Staging System

Jong Woo Lee  1 , Jae Hoon Lee  1 , Yejong Park  1 , Woohyung Lee  1 , Jaewoo Kwon  1 , Ki Byung Song  1 , Dae Wook Hwang  1 , Song Cheol Kim  1
Affiliations
Clinical Trial

Prognostic Predictability of American Joint Committee on Cancer 8th Staging System for Perihilar Cholangiocarcinoma: Limited Improvement Compared with the 7th Staging System

Jong Woo Lee et al. Cancer Res Treat. 2020 Jul.

Abstract

Purpose: This study was conducted to evaluate the prognostic values of the 7th and 8th American Joint Committee on Cancer (AJCC) staging systems for patients with resected perihilar cholangiocarcinoma (PHCC).

Materials and methods: A total of 348 patients who underwent major hepatectomy for PHCC between 2008 and 2015 were identified from a single center. Overall survival (OS) was estimated using the Kaplan-Meier method and compared across stage groups with the log-rank test. The concordance index was used to evaluate the prognostic predictability of the 8th AJCC staging system compared with that of the 7th.

Results: In the 8th edition, the stratification of each group of T classification improved compared to that in the 7th, as the survival rate of T4 decreased (T2, 31.2%; T3, 13.9%; T4, 15.1%; T1-T2, p=0.260; T2-T3, p=0.001; T3-T4, p=0.996). Both editions showed significant survival differences between each N category, except between N1 and N2 (p=0.063) in 7th edition. Differences of point estimates between the 8th and 7th T and N classification and overall stages were +0.028, +0.006, and +0.039, respectively (T, p=0.005; N, p=0.115; overall stage, p=0.005). In multivariable analysis, posthepatectomy liver failure, T category, N category, distant metastasis, histologic differentiation, intraoperative transfusion, and resection margin status were associated with OS.

Conclusion: The prognostic predictability of 8th AJCC staging for PHCC improved slightly, with statistical significance, compared to the 7th edition, but its overall performance is still unsatisfactory.

Keywords: Perihilar cholangiocarcinoma; Prognosis; Stage; Survival.

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Conflict of interest statement

Conflict of interest relevant to this article was not reported.

Figures

Fig. 1.
Fig. 1.
Five-year overall survival (OS) rate. (A) The 7th American Joint Committee on Cancer (AJCC) T classification, T1 vs. T2 (p=0.262), T2 vs. T3 (p < 0.001), T3 vs. T4 (p=0.013). (B) The 8th AJCC T classification., T1 vs. T2 (p=0.260), T2 vs. T3 (p=0.001), T3 vs. T4 (p=0.996).
Fig. 2.
Fig. 2.
Five-year overall survival (OS) rate. (A) The 7th American Joint Committee on Cancer (AJCC) N classification, N0 vs. N1 (p < 0.001), N1 vs. N2 (p=0.063). (B) The 8th AJCC N classification, N0 vs. N1 (p < 0.001), N1 vs. N2 (p=0.016).
Fig. 3.
Fig. 3.
Five-year overall survival (OS) rate according to the 7th American Joint Committee on Cancer (AJCC) stage, I vs. II (p=0.644), II vs. IIIA (p=0.007), IIIA vs. IIIB (p=0.723), IIIB vs. IVA (p=0.047), IVA vs. IVB (p=0.001) (A) and the 8th AJCC stage. I vs. II (p=0.659), II vs. IIIA (p=0.023), IIIA vs. IIIB (p=0.745), IIIB vs. IIIC (p=0.937), IIIC vs. IVA (p=0.024), IVA vs. IVB (p=0.013) (B).
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