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Benefits of the 8th American Joint Committee on Cancer System for Hepatocellular Carcinoma Staging

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Abstract

Purpose

We aimed to emphasize the prognostic impact of differences included in the 8th versus the previous 7th edition of AJCC (American Joint Committee on Cancer) Cancer Staging manual for hepatocellular carcinoma (HCC).

Methods

A number of 87 consecutive HCCs were retrospectively evaluated and staged, using the 7th and 8th edition of AJCC staging systems. The clinicopathological parameters were correlated with the overall survival rate. No preoperative chemotherapy was received by any of the patients.

Results

According to the 7th edition of AJCC manual, 52 of the 87 cases were staged as pT2 and 35 as pT1. After restaging, according to the 8th edition, 23 of the 52 pT2 cases were understaged as pT1b, and the rest of the 29 remained as pT2. Regarding the 35 HCCs classified as pT1, using 7th edition, all of them were restaged as pT1a. Compared to the 7th staging system, using the 8th edition of AJCC manual, the percentage of pT2 tumors significantly decreased, from 59.77 to 33.33%. The patient’s gender, age, tumor focality, and grade of differentiation did not prove to have any prognostic value. Regarding pT stage, it does not influence the overall survival rate, independently from the used staging system.

Conclusion

The staging criteria, in the most recent edition of AJCC, are simplified and allowed tumor understaging. These changes do not have independent prognostic value. The prognostic impact of pT understaging should be evaluated in larger cohorts.

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Availability of Data and Materials

The used data were stored in a database but are confidential data, based on our institutional rules.

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Funding

This study was funded by Romanian National Authority for Scientific Research, CNCS – UEFISCDI, project number 20 PCCF/2018, code: PN-III-P4-ID-PCCF-2016-0006. The financial resources were used for data interpretation only.

Author information

Author notes

  1. Catalin Bogdan Satala and Decebal Fodor contributed equally to this work.

Authors and Affiliations

  1. Department of Pathology, Emil Palade University of Medicine, Pharmacy, Sciences and Technology, 38 Gheorghe Marinescu Street, 530149, Targu-Mures, Romania

    Catalin Bogdan Satala, Ioan Jung, Rita Szodorai & Simona Gurzu

  2. Department of Pathology, Clinical County Emergency Hospital, Targu-Mures, Romania

    Catalin Bogdan Satala, Zsolt Kovacs, Decebal Fodor & Simona Gurzu

  3. Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary

    Laszlo Kobori

  4. Department of Anatomy and Embryology, Emil Palade University of Medicine, Pharmacy, Sciences and Technology, Targu-Mures, Romania

    Decebal Fodor

  5. Department of Pathology, Research Center (CCAMF) of the Emil Palade University of Medicine, Pharmacy, Sciences and Technology, Targu-Mures, Romania

    Simona Gurzu

Authors
  1. Catalin Bogdan Satala
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  2. Ioan Jung
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  3. Laszlo Kobori
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  4. Zsolt Kovacs
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  5. Decebal Fodor
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  6. Rita Szodorai
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  7. Simona Gurzu
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Contributions

SC wrote the manuscript and collected data about Romanian patients, JI performed interpretation of histopathological data, KL supervised collection of data regarding Hungarian patients and performed liver transplantation; KZ performed statistical assessment; SR contributed to data collection and literature review; FD collected clinical data about Hungarian patients; SG supervised the study design and allowed final variant of the manuscript.

Corresponding author

Correspondence to Simona Gurzu.

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Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical approval

For the evaluation of the cases, the approval of Ethical Committee of University of Medicine and Pharmacy of Targu-Mures, Romania, and Semmelweis University, Budapest, Hungary, was obtained. As retrospective evaluation was done, signed informed consent of patients was not necessary.

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Satala, C.B., Jung, I., Kobori, L. et al. Benefits of the 8th American Joint Committee on Cancer System for Hepatocellular Carcinoma Staging. J Gastrointest Canc 52, 243–248 (2021). https://doi.org/10.1007/s12029-020-00394-z

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  • DOI: https://doi.org/10.1007/s12029-020-00394-z

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