Skip to main content

Advertisement

SpringerLink
Log in

Staging of Peripheral-Type Intrahepatic Cholangiocarcinoma: Appraisal of the New TNM Classification and its Modifications

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

In the seventh edition, the TNM classification for intrahepatic cholangiocarcinoma (IHC) is separated from that for hepatocellular carcinoma. Because it is the first independent classification for IHC, the validity of the new classification needs to be evaluated.

Methods

The medical records of 93 patients with peripheral-type IHC who underwent treatment (61 resected and 32 unresectable tumors) were retrospectively reviewed focusing on the new TNM classification for IHC.

Results

The 5-year survival rate and the median survival time for the 61 patients with resected tumors were 33.9% and 2.05 years, respectively. The survival of the patients with periductal invasion was similar to that of the patients without. The survival of the patients with metastasis to the gastrohepatic lymph nodes (G-LN) was dismal without any 2-year survivors and similar to that of the patients with unresectable tumors (P = 0.247). On multivariate analysis, histologic differentiation (P = 0.034), multiple tumors (P = 0.014), lymph node metastasis (P < 0.001), and distant metastasis other than lymph node metastasis (P = 0.007) were identified as independent prognostic factors. According to the above results, we modified the new TNM classification as follows: IHC with multiple tumors was classified as pT4 disease; periductal invasion was excluded from determinant of the T-categories; and metastasis to G-LN was treated as distant metastasis. The survival curves based on our modifications were better stratified than those based on the new TNM classification.

Conclusions

The TNM classification for IHC included some clinical inconsistencies; therefore, we proposed some modifications of the new TNM classification for IHC and demonstrated that these modifications offer better stratification of the survival data. Further revisions are necessary for its improvement.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Edge SB, Byrd DR, Compton CC et al (eds) (2009) AJCC cancer staging manual, 7th edn. Springer, New York

    Google Scholar 

  2. Sobin LH, Gospodarowicz MK, Wittekind C (eds) (2009) International Union Against Cancer (UICC). TNM classification of malignant tumours, 7th edn. Wiley-Blackwell, Oxford

  3. Nakeeb A, Pitt HA, Sohn TA et al (1996) Cholangiocarcinoma. A spectrum of intrahepatic, perihilar, and distal tumors. Ann Surg 224:463–473

    Article  PubMed  CAS  Google Scholar 

  4. Ebata T, Kamiya J, Nishio H et al (2009) The concept of perihilar cholangiocarcinoma. Br J Surg 96:926–934

    Article  PubMed  CAS  Google Scholar 

  5. Nimura Y, Hayakawa N, Kamiya J et al (1991) Combined portal vein and liver resection for carcinoma of the biliary tract. Br J Surg 78:727–731

    Article  PubMed  CAS  Google Scholar 

  6. Ebata T, Nagino M, Kamiya J et al (2003) Hepatectomy with portal vein resection for hilar cholangiocarcinoma: audit of 52 consecutive cases. Ann Surg 238:720–727

    Article  PubMed  Google Scholar 

  7. Miyazaki M, Kato A, Ito H et al (2007) Combined vascular resection in operative resection for hilar cholangiocarcinoma: does it work or not? Surgery 141:581–588

    Article  PubMed  Google Scholar 

  8. Nagino M, Yamada T, Kamiya J et al (2003) Left hepatic trisegmentectomy with right hepatic vein resection after right hepatic vein embolization. Surgery 133:580–582

    Article  PubMed  Google Scholar 

  9. Nagino M, Nimura Y, Nishio H et al (2010) Hepatectomy with simultaneous resection of the portal vein and hepatic artery for advanced perihilar cholangiocarcinoma: an audit of 50 consecutive cases. Ann Surg 252:115–123

    Article  PubMed  Google Scholar 

  10. Nozaki Y, Yamamoto M, Ikai I et al (1998) Reconsideration of the lymph node metastasis pattern (N factor) from intrahepatic cholangiocarcinoma using the International Union Against Cancer TNM staging system for primary liver carcinoma. Cancer 83:1923–1929

    Article  PubMed  CAS  Google Scholar 

  11. Okabayashi T, Yamamoto J, Kosuge T et al (2001) A new staging system for mass-forming intrahepatic cholangiocarcinoma: analysis of preoperative and postoperative variables. Cancer 92:2374–2383

    Article  PubMed  CAS  Google Scholar 

  12. Yamasaki S (2003) Intrahepatic cholangiocarcinoma: macroscopic type and stage classification. J Hepatobiliary Pancreat Surg 10:288–291

    Article  PubMed  Google Scholar 

  13. Nathan H, Aloia TA, Vauthey JN et al (2009) A proposed staging system for intrahepatic cholangiocarcinoma. Ann Surg Oncol 16:14–22

    Article  PubMed  Google Scholar 

  14. Jonas S, Thelen A, Benckert C et al (2009) Extended liver resection for intrahepatic cholangiocarcinoma: a comparison of the prognostic accuracy of the fifth and sixth editions of the TNM classification. Ann Surg 249:303–309

    Article  PubMed  Google Scholar 

  15. Uenishi T, Kubo S, Yamazaki O et al (2008) Indication for surgical treatment of intrahepatic cholangiocarcinoma with lymph node metastases. J Hepatobiliary Pancreat Surg 15:417–422

    Article  PubMed  Google Scholar 

  16. Nakagohri T, Kinoshita T, Konishi M et al (2008) Surgical outcome and prognostic factors in intrahepatic cholangiocarcinoma. World J Surg 32:2675–2680. doi:10.1007/s00268-008-9778-3

    Article  PubMed  Google Scholar 

  17. Hirohashi K, Uenishi T, Kubo S et al (2002) Macroscopic types of intrahepatic cholangiocarcinoma: clinicopathologic features and surgical outcomes. Hepatogastroenterology 49:326–329

    PubMed  Google Scholar 

  18. Suzuki S, Sakaguchi T, Yokoi Y et al (2002) Clinicopathological prognostic factors and impact of surgical treatment of mass-forming type intrahepatic cholangiocarcinoma. World J Surg 26:687–693. doi:10.1007/s00268-001-0291-1

    Article  PubMed  Google Scholar 

  19. Nakagawa T, Kamiyama T, Kurauchi N et al (2005) Number of lymph node metastases is a significant prognostic factor in intrahepatic cholangiocarcinoma. World J Surg 29:728–733. doi:10.1007/s00268-005-7761-9

    Article  PubMed  Google Scholar 

  20. Ohtsuka M, Ito H, Kimura F et al (2002) Results of surgical treatment for intrahepatic cholangiocarcinoma and clinicopathological factors influencing survival. Br J Surg 89:1525–1531

    Article  PubMed  CAS  Google Scholar 

  21. Endo I, Gonen M, Yopp AC et al (2008) Intrahepatic cholangiocarcinoma: rising frequency, improved survival, and determinants of outcome after resection. Ann Surg 248:84–96

    Article  PubMed  Google Scholar 

  22. Shimada K, Sano T, Nara S et al (2009) Therapeutic value of lymph node dissection during hepatectomy in patients with intrahepatic cholangiocellular carcinoma with negative lymph node involvement. Surgery 145:411–416

    Article  PubMed  Google Scholar 

  23. Paik KY, Jung JC, Heo JS et al (2008) What prognostic factors are important for resected intrahepatic cholangiocarcinoma? J Gastroenterol Hepatol 23:766–770

    Article  PubMed  Google Scholar 

  24. Tamandl D, Herberger B, Gruenberger B et al (2008) Influence of hepatic margin on recurrence and survival in intrahepatic cholangiocarcinoma. Ann Surg Oncol 15:2787–2794

    Article  PubMed  Google Scholar 

  25. Valverde A, Bonhomme N, Farges O et al (1999) Resection of intrahepatic cholangiocarcinoma: a western experience. J Hepatobiliary Pancreat Surg 2:122–127

    Article  Google Scholar 

  26. Guglielmi A, Ruzzenente A, Campagnaro T et al (2009) Intrahepatic cholangiocarcinoma: prognostic factors after surgical resection. World J Surg 33:1247–1254. doi:10.1007/s00268-009-9970-0

    Article  PubMed  Google Scholar 

  27. Tamandl D, Kaczirek K, Gruenberger B et al (2009) Lymph node ratio after curative surgery for intrahepatic cholangiocarcinoma. Br J Surg 96:919–925

    Article  PubMed  CAS  Google Scholar 

  28. Uenishi T, Yamazaki O, Yamamoto T et al (2005) Serosal invasion in TNM staging of mass-forming intrahepatic cholangiocarcinoma. J Hepatobiliary Pancreat Surg 12:479–483

    Article  PubMed  Google Scholar 

  29. Choi SB, Kim KS, Choi JY et al (2009) The prognosis and survival outcome of intrahepatic cholangiocarcinoma following surgical resection: association of lymph node metastasis and lymph node dissection with survival. Ann Surg Oncol 16:3048–3056

    Article  PubMed  Google Scholar 

  30. Shimada M, Yamashita Y, Aishima S et al (2001) Value of lymph node dissection during resection of intrahepatic cholangiocarcinoma. Br J Surg 88:1463–1466

    Article  PubMed  CAS  Google Scholar 

  31. Tsuji T, Hiraoka T, Kanemitsu K et al (2001) Lymphatic spreading pattern of intrahepatic cholangiocarcinoma. Surgery 129:401–407

    PubMed  CAS  Google Scholar 

  32. Yedibela S, Demir R, Zhang W et al (2009) Surgical treatment of mass-forming intrahepatic cholangiocarcinoma: an 11-year western single-center experience in 107 patients. Ann Surg Oncol 16:404–412

    Article  PubMed  Google Scholar 

  33. Kawarada Y, Yamagiwa K, Das BC (2002) Analysis of the relationships between clinicopathologic factors and survival time in intrahepatic cholangiocarcinoma. Am J Surg 183:679–685

    Article  PubMed  Google Scholar 

  34. Inoue K, Makuuchi M, Takayama T et al (2000) Long-term survival and prognostic factors in the surgical treatment of mass-forming type cholangiocarcinoma. Surgery 127:498–505

    Article  PubMed  CAS  Google Scholar 

  35. Shirabe K, Shimada M, Harimoto N et al (2002) Intrahepatic cholangiocarcinoma: its mode of spreading and therapeutic modalities. Surgery 131:S159–S164

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan

    Tsuyoshi Igami, Tomoki Ebata, Yukihiro Yokoyama, Gen Sugawara, Yu Takahashi & Masato Nagino

Authors
  1. Tsuyoshi Igami
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tomoki Ebata
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yukihiro Yokoyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gen Sugawara
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yu Takahashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Masato Nagino
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Masato Nagino.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Igami, T., Ebata, T., Yokoyama, Y. et al. Staging of Peripheral-Type Intrahepatic Cholangiocarcinoma: Appraisal of the New TNM Classification and its Modifications. World J Surg 35, 2501–2509 (2011). https://doi.org/10.1007/s00268-011-1242-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-011-1242-0

Keywords

Search

Navigation