Cancer Res Treat.  2019 Jan;51(1):98-111. 10.4143/crt.2017.595.

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

Affiliations
  • 1Department of Pathology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea.
  • 2Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. smhong28@gmail.com
  • 3Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

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.

Keyword

Bile duct; Extrahepatic; Cholangiocarcinoma; Neoplasm; Staging

MeSH Terms

Bile Ducts*
Bile*
Cholangiocarcinoma
Classification
Humans
Joints*
Multivariate Analysis
Neoplasm Staging*
Prognosis
Survival Rate
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