Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
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.

PubMed Disclaimer

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).
See this image and copyright information in PMC

References

    1. Ebata T, Kamiya J, Nishio H, Nagasaka T, Nimura Y, Nagino M. The concept of perihilar cholangiocarcinoma is valid. Br J Surg. 2009;96:926–34. - PubMed
    1. Ebata T, Kosuge T, Hirano S, Unno M, Yamamoto M, Miyazaki M, et al. Proposal to modify the International Union Against Cancer staging system for perihilar cholangiocarcinomas. Br J Surg. 2014;101:79–88. - PubMed
    1. Chun YS, Pawlik TM, Vauthey JN. 8th edition of the AJCC cancer staging manual: pancreas and hepatobiliary cancers. Ann Surg Oncol. 2018;25:845–7. - PubMed
    1. Steyerberg EW, Vickers AJ, Cook NR, Gerds T, Gonen M, Obuchowski N, et al. Assessing the performance of prediction models: a framework for traditional and novel measures. Epidemiology. 2010;21:128–38. - PMC - PubMed
    1. Ebata T, Nagino M, Kamiya J, Uesaka K, Nagasaka T, Nimura Y. Hepatectomy with portal vein resection for hilar cholangiocarcinoma: audit of 52 consecutive cases. Ann Surg. 2003;238:720–7. - PMC - PubMed