Abstract
Background
AJCC staging system is unreliable for predicting survival in distal bile duct (DBD) cancer patients, due to inter-observer variation. Measured depth of invasion (DOI) is suggested to be more accurate to predict patients’ clinical outcome in extra-hepatic cholangiocarcinomas, but its significance in DBD cancer and cutoff values are still debatable. This study aimed to identify the optimal cutoff value of DOI in relation to prognosis in DBD cancer patients.
Methods
Data of 179 patients with DBD adenocarcinoma treated in three institutions were investigated. Under microscopic review, DOI was measured. The relationships between the clinicopathological parameters and the groups based on DOI (≤3; 3–10; >10 mm) were evaluated, and the survival times of each group based on DOI and T classification were compared.
Results
Deeply invading tumors exhibited a greater tendency toward the infiltrative type, high histological grade, AJCC stage, and pancreatic, duodenal, lymphovascular and perineural invasion. The measured DOI was significantly correlated with worse relapse-free and overall survival (all p < 0.05). In multivariate analyses, the DOI remained as one of the prognostic factors (all p < 0.05), while T classification was not a significant prognostic factor. The new prognostic models (low, intermediate, and high risk) that applied DOI and nodal metastasis showed significant difference in recurrence and survival rate (all p < 0.05).
Conclusions
On the basis of the proposed cutoff value, the DOI could be clear and meaningful, overcoming the vagueness of the T classification for predicting clinical outcomes in patients with DBD carcinoma.
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Abbreviations
- DOI:
-
Depth of invasion
- DBD:
-
Distal bile duct
- PBD:
-
Perihilar bile duct
- AJCC:
-
American Joint Committee on Cancer
- REMARK:
-
Reporting recommendations for tumor marker prognostic studies
- ROC:
-
Receiver operating characteristic
References
Jarnagin WR, Shoup M (2004) Surgical management of cholangiocarcinoma. Semin Liver Dis 24:189–199
Shaib Y, El-Serag HB (2004) The epidemiology of cholangiocarcinoma. Semin Liver Dis 24:115–125
Han SS, Jang JY, Lee KU, Kim SW (2008) Actual long-term outcome of Klatskin’s tumor after surgical resection. Hepatogastroenterology 55:1986–1992
DeOliveira ML, Cunningham SC, Cameron JL et al (2007) Cholangiocarcinoma: thirty-one-year experience with 564 patients at a single institution. Ann Surg 245:755–762
Kawai M, Tani M, Kobayashi Y et al (2010) The ratio between metastatic and examined lymph nodes is an independent prognostic factor for patients with resectable middle and distal bile duct carcinoma. Am J Surg 199:447–452
Moon A, Choi DW, Choi SH et al (2015) Validation of T stage according to depth of invasion and N stage subclassification based on number of metastatic lymph nodes for distal extrahepatic bile duct (EBD) carcinoma. Medicine 94:e2064
Hong SM, Pawlik TM, Cho H et al (2009) Depth of tumor invasion better predicts prognosis than the current American Joint Committee on Cancer T classification for distal bile duct carcinoma. Surgery 146:250–257
Zervos EE, Osborne D, Goldin SB et al (2005) Stage does not predict survival after resection of hilar cholangiocarcinomas promoting an aggressive operative approach. Am J Surg 190:810–815
Yoshimi F, Asato Y, Amemiya R et al (2001) Comparison between pancreatoduodenectomy and hepatopancreatoduodenectomy for bile duct cancer. Hepatogastroenterology 48:994–998
Kim JH, Bae JM, Oh HJ et al (2015) Pathologic factors associated with prognosis after adjuvant chemotherapy in stage II/III microsatellite-unstable colorectal cancers. J Pathol Transl Med 49:118–128
Hong SM, Cho H, Moskaluk CA, Yu E (2007) Measurement of the invasion depth of extrahepatic bile duct carcinoma: an alternative method overcoming the current T classification problems of the AJCC staging system. Am J Surg Pathol 31:199–206
Hong SM, Presley AE, Stelow EB et al (2006) Reconsideration of the histologic definitions used in the pathologic staging of extrahepatic bile duct carcinoma. J Surg Pathol 30:744–749
Adsay NV, Bagci P, Tajiri T et al (2012) Pathologic staging of pancreatic, ampullary, biliary, and gallbladder cancers: pitfalls and practical limitations of the current AJCC/UICC TNM staging system and opportunities for improvement. Semin Diagn Pathol 29:127–141
van den Einden LC, Massuger LF, Jonkman JK et al (2015) An alternative way to measure the depth of invasion of vulvar squamous cell carcinoma in relation to prognosis. Mod Pathol 28:295–302
Kaku T, Kamura T, Sakai K et al (1997) Early adenocarcinoma of the uterine cervix. Gynecol Oncol 65:281–285
Zarei S, Frank I, Boorjian SA et al (2012) Prognostic significance of measured depth of invasion of urothelial carcinoma of the bladder compared to the 2010 American Joint Committee on Cancer pT2 and pT3 classifications. J Urol 188:1706–1711
Corsetti RL, Allen HM, Wanebo HJ (2000) Thin < or = 1 mm level III and IV melanomas are higher risk lesions for regional failure and warrant sentinel lymph node biopsy. Ann Surg Oncol 7:456–460
Suzuki H, Fukuyama R, Hasegawa Y et al (2009) Tumor thickness, depth of invasion, and Bcl-2 expression are correlated with FDG-uptake in oral squamous cell carcinomas. Oral Oncol 45:891–897
Acknowledgments
We are grateful to our English teacher, Ina Jeong, for editing this manuscript.
Funding
This work was supported by Hanmi Pharm (IIT-ESO-009) in 2015.
Authors’ contributions
K-WM contributed to acquisition and analysis of clinicopathological data, statistical analyses and manuscript preparation. E-KK, SBA, SHK, YJJ, YSP, JYJ, HIH, JWL, YHO, SO and HYK contributed to the collection of clinical data and the evaluation of histological results. JS, MJK, SKM, H-RP and J-YC contributed to statistical analyses and English proofreading. D-HK and BKS contributed to study design and data interpretation and supervised the study. All authors read and approved the submitted version.
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The authors have no conflict of interest to declare.
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This study was approved by the Ethics Committee of the Eulji General Hospital (EMCIRB 15-24), and it was performed in accordance with the ethical standards of the Declaration of Helsinki, as revised in 2008.
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Kyueng-Whan Min and Dong-Hoon Kim have contributed equally to this work.
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Min, KW., Kim, DH., Son, B.K. et al. Invasion Depth Measured in Millimeters is a Predictor of Survival in Patients with Distal Bile Duct Cancer: Decision Tree Approach. World J Surg 41, 232–240 (2017). https://doi.org/10.1007/s00268-016-3687-7
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DOI: https://doi.org/10.1007/s00268-016-3687-7