Skip to main content
SpringerLink
Log in

A Comparison of Prognostic Schemes for Perihilar Cholangiocarcinoma

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Introduction

Although widely used, the 7th edition American Joint Committee on Cancer (AJCC) staging system for perihilar cholangiocarcinoma (PHC) may be limited. Disease-specific nomograms have been proposed as a better means to predict long-term survival for individual patients. We sought to externally validate a recently proposed nomogram by Memorial Sloan Kettering Cancer Center (MSKCC) for PHC, as well as identify factors to improve the prediction of prognosis for patients with PHC.

Methods

Four hundred seven patients who underwent surgery for PHC between 1988 and 2014 were identified using an international, multi-center database. Standard clinicopathologic and outcome data were collected. The predictive power of the AJCC staging system and nomogram were assessed.

Results

Median survival was 24.4 months; 3- and 5-year survival was 37.2 and 20.8 %, respectively. The AJCC 7th edition staging system (C-index 0.570) and the recently proposed PHC nomogram (C-index 0.587) both performed poorly. A revised nomogram based on age, lymphovascular invasion, perineural invasion, and lymph node metastases performed better (C-index 0.682). The calibration plot of the revised PHC nomogram demonstrated good calibration.

Conclusion

The 7th edition AJCC staging system and the MSKCC nomogram had a poor ability to predict long-term survival for individual patients with PHC. A revised nomogram provided more accurate prediction of survival, but will need to be externally validated.

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. Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. CA Cancer J Clin. 2014;64(1):9–29.

    Article  PubMed  Google Scholar 

  2. DeOliveira ML, Cunningham SC, Cameron JL, Kamangar F, Winter JM, Lillemoe KD, Choti MA, Yeo CJ, Schulick RD. Cholangiocarcinoma: thirty-one-year experience with 564 patients at a single institution. Ann Surg. 2007;245(5):755–762.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Burke EC, Jarnagin WR, Hochwald SN, Pisters PW, Fong Y, Blumgart LH. Hilar Cholangiocarcinoma: patterns of spread, the importance of hepatic resection for curative operation, and a presurgical clinical staging system. Ann Surg. 1998;228(3):385–394.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Ruzzenente A, Valdegamberi A, Iacono C, Bagante F, Bertuzzo F, Campagnaro T, Conci S, Mantovani G, De Angelis M, Guglielmi A. A new prognostic nomogram for perihilar cholangiocarcinoma after surgical resection: Comparison with the current staging systems. HPB. 2014;16:130.

    Google Scholar 

  5. Wakabayashi H, Ishimura K, Hashimoto N, Otani T, Kondo A, Maeta H. Analysis of prognostic factors after surgery for stage III and IV gallbladder cancer. Eur J Surg Oncol. 2004;30(8):842–846.

    Article  CAS  PubMed  Google Scholar 

  6. Lepage C, Capocaccia R, Hackl M, Lemmens V, Molina E, Pierannunzio D, Sant M, Trama A, Faivre J, Grouph E-W. Survival in patients with primary liver cancer, gallbladder and extrahepatic biliary tract cancer and pancreatic cancer in Europe 1999–2007: Results of EUROCARE-5. Eur J Cancer. 2015. doi: 10.1016/j.ejca.2015.07.034

    PubMed  Google Scholar 

  7. Popescu I, Dumitrascu T. Curative-intent surgery for hilar cholangiocarcinoma: prognostic factors for clinical decision making. Langenbecks Arch Surg. 2014;399(6):693–705.

    Article  PubMed  Google Scholar 

  8. Zhang W, Yan LN. Perihilar cholangiocarcinoma: Current therapy. World J Gastrointest Pathophysiol. 2014;5(3):344–354.

    PubMed  PubMed Central  Google Scholar 

  9. Nakeeb A, Tran KQ, Black MJ, Erickson BA, Ritch PS, Quebbeman EJ, Wilson SD, Demeure MJ, Rilling WS, Dua KS, Pitt HA. Improved survival in resected biliary malignancies. Surgery. 2002;132(4):555–563.

    Article  PubMed  Google Scholar 

  10. Groot Koerkamp B, Wiggers JK, Allen PJ, Busch OR, D’Angelica MI, DeMatteo RP, Fong Y, Gonen M, Gouma DJ, Kingham TP, van Gulik TM, Jarnagin WR. American Joint Committee on Cancer staging for resected perihilar cholangiocarcinoma: a comparison of the 6th and 7th editions. HPB (Oxford). 2014;16(12):1074–1082. doi: 10.1111/hpb.12320

    Article  Google Scholar 

  11. Ebata T, Kosuge T, Hirano S, Unno M, Yamamoto M, Miyazaki M, Kokudo N, Miyagawa S, Takada T, Nagino M. Proposal to modify the International Union Against Cancer staging system for perihilar cholangiocarcinomas. Br J Surg. 2014;101(2):79–88.

    Article  CAS  PubMed  Google Scholar 

  12. Nuzzo G, Giuliante F, Ardito F, Giovannini I, Aldrighetti L, Belli G, Bresadola F, Calise F, Dalla Valle R, D’Amico DF, Gennari L, Giulini SM, Guglielmi A, Jovine E, Pellicci R, Pernthaler H, Pinna AD, Puleo S, Torzilli G, Capussotti L, Italian Chapter of the International Hepato-Pancreato-Biliary A, Cillo U, Ercolani G, Ferrucci M, Mastrangelo L, Portolani N, Pulitano C, Ribero D, Ruzzenente A, Scuderi V, Federico B. Improvement in perioperative and long-term outcome after surgical treatment of hilar cholangiocarcinoma: results of an Italian multicenter analysis of 440 patients. Arch Surg. 2012;147(1):26–34

    Article  PubMed  Google Scholar 

  13. Lee SG, Song GW, Hwang S, Ha TY, Moon DB, Jung DH, Kim KH, Ahn CS, Kim MH, Lee SK, Sung KB, Ko GY. Surgical treatment of hilar cholangiocarcinoma in the new era: the Asan experience. J Hepatobiliary Pancreat Sci. 2010;17(4):476–489.

    Article  PubMed  Google Scholar 

  14. Furusawa N, Kobayashi A, Yokoyama T, Shimizu A, Motoyama H, Miyagawa S. Surgical treatment of 144 cases of hilar cholangiocarcinoma without liver-related mortality. World J Surg. 2014;38(5):1164–1176.

    Article  PubMed  Google Scholar 

  15. Song SC, Choi DW, Kow AW, Choi SH, Heo JS, Kim WS, Kim MJ. Surgical outcomes of 230 resected hilar cholangiocarcinoma in a single centre. ANZ J Surg. 2013;83(4):268–274.

    Article  PubMed  Google Scholar 

  16. Klempnauer J, Ridder GJ, von Wasielewski R, Werner M, Weimann A, Pichlmayr R. Resectional surgery of hilar cholangiocarcinoma: a multivariate analysis of prognostic factors. J Clin Oncol. 1997;15(3):947–954.

    CAS  PubMed  Google Scholar 

  17. Jarnagin WR, Fong Y, DeMatteo RP, Gonen M, Burke EC, Bodniewicz BJ, Youssef BM, Klimstra D, Blumgart LH. Staging, resectability, and outcome in 225 patients with hilar cholangiocarcinoma. Ann Surg. 2001;234(4):507–517.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Bismuth H, Corlette MB. Intrahepatic cholangioenteric anastomosis in carcinoma of the hilus of the liver. Surg Gynecol Obstet. 1975;140(2):170–178.

    CAS  PubMed  Google Scholar 

  19. Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A. AJCC Cancer Staging Manual. 7th ed. Chicago: Springer; 2009.

    Google Scholar 

  20. Groot Koerkamp B, Wiggers JK, Gonen M, Doussot A, Allen PJ, Besselink MG, Blumgart LH, Busch OR, D’Angelica MI, DeMatteo RP, Gouma DJ, Kingham TP, van Gulik TM, Jarnagin WR. Survival after resection of perihilar cholangiocarcinoma-development and external validation of a prognostic nomogram. Ann Oncol. 2015;26(9):1930–1935.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Wang Y, Li J, Xia Y, Gong R, Wang K, Yan Z, Wan X, Liu G, Wu D, Shi L, Lau W, Wu M, Shen F. Prognostic nomogram for intrahepatic cholangiocarcinoma after partial hepatectomy. J Clin Oncol. 2013;31(9):1188–1195.

    Article  PubMed  Google Scholar 

  22. Wierda WG, O’Brien S, Wang X, Faderl S, Ferrajoli A, Do KA, Cortes J, Thomas D, Garcia-Manero G, Koller C, Beran M, Giles F, Ravandi F, Lerner S, Kantarjian H, Keating M. Prognostic nomogram and index for overall survival in previously untreated patients with chronic lymphocytic leukemia. Blood. 2007;109(11):4679–4685.

    Article  CAS  PubMed  Google Scholar 

  23. Karakiewicz PI, Briganti A, Chun FK, Trinh QD, Perrotte P, Ficarra V, Cindolo L, De la Taille A, Tostain J, Mulders PF, Salomon L, Zigeuner R, Prayer-Galetti T, Chautard D, Valeri A, Lechevallier E, Descotes JL, Lang H, Mejean A, Patard JJ. Multi-institutional validation of a new renal cancer-specific survival nomogram. J Clin Oncol. 2007;25(11):1316–1322.

    Article  PubMed  Google Scholar 

  24. International Bladder Cancer Nomogram C, Bochner BH, Kattan MW, Vora KC. Postoperative nomogram predicting risk of recurrence after radical cystectomy for bladder cancer. J Clin Oncol. 2006;24(24):3967–3972.

    Article  Google Scholar 

  25. Horgan AM, Amir E, Walter T, Knox JJ. Adjuvant therapy in the treatment of biliary tract cancer: a systematic review and meta-analysis. J Clin Oncol. 2012;30(16):1934–1940.

    Article  PubMed  Google Scholar 

Download references

Authors’ Contributions

Study concept and design: Buettner, van Vugt, Gani, Koerkamp, Margonis, Maithel, Guglielmi, IJzermans, Pawlik

Acquisition of data: Buettner, Margonis, Ethun, Poultsides, Tran, Idrees, Isom, Fields, Krasnick, Weber, Salem, Martin, Scoggins, Shen, Mogal, Schmidt, Beal, Hatzaras, Shenoy, Maithel, Pawlik

Analysis or interpretation of data: Buettner, van Vugt, Gani, Koerkamp, Margonis, Guglielmi, IJzermans, Pawlik

Drafting of the final manuscript: Buettner, van Vugt, Gani, Koerkamp, Margonis, Guglielmi, IJzermans, Pawlik

Critical review of the manuscript: Buettner, van Vugt, Gani, Koerkamp, Margonis, Ethun, Poultsides, Tran, Idrees, Isom, Fields, Krasnick, Weber, Salem, Martin, Scoggins, Shen, Mogal, Schmidt, Beal, Hatzaras, Shenoy, Maithel, Guglielmi, IJzermans, Pawlik

Final approval of the manuscript: Buettner, van Vugt, Gani, Koerkamp, Margonis, Ethun, Poultsides, Tran, Idrees, Isom, Fields, Krasnick, Weber, Salem, Martin, Scoggins, Shen, Mogal, Schmidt, Beal, Hatzaras, Shenoy, Maithel, Guglielmi, IJzermans, Pawlik

All authors agree to the publication of this work and agree to being held accountable to the accuracy and integrity of the work.

Author information

Authors and Affiliations

  1. Department of Surgery, Johns Hopkins Hospital, 600 N. Wolfe Street, Blalock 688, Baltimore, MD, 21287, USA

    Stefan Buettner, Faiz Gani, Georgios Antonios Margonis & Timothy M. Pawlik

  2. Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands

    Stefan Buettner, Jeroen L. A. van Vugt, Bas Groot Koerkamp & Jan N. M. IJzermans

  3. Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA

    Cecilia G. Ethun & Shishir K. Maithel

  4. Department of Surgery, Stanford University Medical Center, Stanford, CA, USA

    George Poultsides & Thuy Tran

  5. Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA

    Kamran Idrees & Chelsea A. Isom

  6. Department of Surgery, Washington University School of Medicine, St Louis, MO, USA

    Ryan C. Fields & Bradley Krasnick

  7. Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Sharon M. Weber & Ahmed Salem

  8. Department of Surgery, University of Louisville, Louisville, KY, USA

    Robert C. G. Martin & Charles Scoggins

  9. Department of Surgery, Wake Forest University, Winston-Salem, NC, USA

    Perry Shen & Harveshp D. Mogal

  10. Department of Surgery, Ohio State University, Columbus, OH, USA

    Carl Schmidt & Eliza Beal

  11. Department of Surgery, New York University, New York, NY, USA

    Ioannis Hatzaras & Rivfka Shenoy

  12. Department of Surgery, Verona University Medical Center, Verona, Italy

    Alfredo Guglielmi

Authors
  1. Stefan Buettner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jeroen L. A. van Vugt
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Faiz Gani
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Bas Groot Koerkamp
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Georgios Antonios Margonis
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Cecilia G. Ethun
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. George Poultsides
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Thuy Tran
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Kamran Idrees
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Chelsea A. Isom
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Ryan C. Fields
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Bradley Krasnick
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Sharon M. Weber
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Ahmed Salem
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Robert C. G. Martin
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Charles Scoggins
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Perry Shen
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Harveshp D. Mogal
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Carl Schmidt
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. Eliza Beal
    View author publications

    You can also search for this author in PubMed Google Scholar

  21. Ioannis Hatzaras
    View author publications

    You can also search for this author in PubMed Google Scholar

  22. Rivfka Shenoy
    View author publications

    You can also search for this author in PubMed Google Scholar

  23. Shishir K. Maithel
    View author publications

    You can also search for this author in PubMed Google Scholar

  24. Alfredo Guglielmi
    View author publications

    You can also search for this author in PubMed Google Scholar

  25. Jan N. M. IJzermans
    View author publications

    You can also search for this author in PubMed Google Scholar

  26. Timothy M. Pawlik
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Timothy M. Pawlik.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Funding

None.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Buettner, S., van Vugt, J.L.A., Gani, F. et al. A Comparison of Prognostic Schemes for Perihilar Cholangiocarcinoma. J Gastrointest Surg 20, 1716–1724 (2016). https://doi.org/10.1007/s11605-016-3203-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-016-3203-2

Keywords

Search

Navigation