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The Evaluation of the Eighth Edition of the AJCC/UICC Staging System for Intrahepatic Cholangiocarcinoma: a Proposal of a Modified New Staging System

  • Original Article
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Journal of Gastrointestinal Surgery

Abstract

Background

The objective was to clarify the prognostic impact of the 8th edition of American Joint Committee on Cancer (AJCC)/International Union Against Cancer (UICC) of intrahepatic cholangiocarcinoma (ICC).

Methods

A total of 103 ICC patients who underwent hepatectomy between 2002 and 2016 were enrolled. The survival impact of AJCC/UICC 8th edition was examined.

Results

The 5-year disease-specific survival (DSS) rate was 75.9% in T1a (n = 23), 88.9% in T1b (n = 10), 14.9% in T2 (n = 24), 52.5% in T3 (n = 11), and 15.2% in T4 (n = 35). The DSS was comparable among T2, T3, and T4 (T2 vs. T3; p = 0.345, T3 vs. T4; 0.295). A multivariate analysis identified multiple tumors (hazard ratio [HR] 2.821), periductal infiltrating (HR 2.439), perforation of the visceral peritoneum (HR 1.850), and vascular invasion (HR 1.872) as independent prognostic factors that were associated with the DSS. The optimum tumor size with the greatest difference in the DSS was 2 cm (p = 0.014). The new T classification was developed as follows: T1, size ≤ 2 cm without other factors; T2, size > 2 cm without other factors; T3, vascular invasion or perforation of the visceral peritoneum; and T4, multiple tumors or periductal infiltrating. The 5-year DSS was 100% in T1 (n = 7), 76.6% in T2 (n = 28), 45.1% in T3 (n = 28), and 3.4% in T4 (n = 40). There were differences in the DSS between T2 and T3 (p = 0.035) and between T3 and T4 (p = 0.003).

Conclusions

T2, T3, and T4 of AJCC/UICC overlapped with regard to the DSS. The new staging can classify ICC patients with sufficient prognostic differences.

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Abbreviations

ICC:

Intrahepatic cholangiocarcinoma

TNM:

Tumor-node-metastasis

AJCC:

American Joint Committee on Cancer

UICC:

International Union Against Cancer

HR:

Hazard ratio

LCSGJ:

Liver Cancer Study Group of Japan

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Authors and Affiliations

  1. Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007, Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka, 4118777, Japan

    Yusuke Yamamoto, Teiichi Sugiura, Yukiyasu Okamura, Takaaki Ito, Ryo Ashida, Katsuhisa Ohgi & Katsuhiko Uesaka

  2. Division of Pathology, Shizuoka Cancer Center, Sunto-Nagaizumi, Shizuoka, Japan

    Yasuni Nakanuma

Authors
  1. Yusuke Yamamoto
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  2. Teiichi Sugiura
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  3. Yukiyasu Okamura
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  4. Takaaki Ito
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  5. Ryo Ashida
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  6. Katsuhisa Ohgi
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  7. Yasuni Nakanuma
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  8. Katsuhiko Uesaka
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Contributions

Design of work: Y Yamamoto, T Sugiura, and K Uesaka

Acquisition, analysis, and interpretation of data: Y Yamamoto, T Sugiura, Y Okamura, T Ito, R Ashida, K Ohgi, and Y Nakanuma

Drafting and revising: Y Yamamoto, T Sugiura, Y Okamura, T Ito, R Ashida, K Ohgi, and K Uesaka

Final approval: Y Yamamoto, T Sugiura, Y Okamura, T Ito, R Ashida, K Ohgi, and K Uesaka

Agreement to be accountable for all aspects of the work: Y Yamamoto, T Sugiura, Y Okamura, T Ito, R Ashida, K Ohgi, Y Nakanuma, and K Uesaka

Corresponding author

Correspondence to Yusuke Yamamoto.

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The Institutional Review Board approved this study.

Conflict of Interest

The authors declare that they have no conflicts of interest.

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Summary

T2, T3, and T4 of AJCC/UICC of intrahepatic cholangiocarcinoma overlapped with regard to the survival. The new classification was developed: T1, size ≤ 2cm; T2, size > 2cm; T3, vascular invasion or perforation of the visceral peritoneum; and T4, multiple tumors or periductal infiltrating. This staging can classify with sufficient prognostic differences.

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Yamamoto, Y., Sugiura, T., Okamura, Y. et al. The Evaluation of the Eighth Edition of the AJCC/UICC Staging System for Intrahepatic Cholangiocarcinoma: a Proposal of a Modified New Staging System. J Gastrointest Surg 24, 786–795 (2020). https://doi.org/10.1007/s11605-019-04185-1

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  • DOI: https://doi.org/10.1007/s11605-019-04185-1

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