Abstract
BACKGROUND: The eighth edition of the American Joint Committee on Cancer (AJCC) staging system for gallbladder cancer (GBC) redefined the N category. This study aimed to evaluate whether the staging associated with N (stage IIIB, IVA and IVB) was appropriate. METHODS: Patients with stage IIIB, IVA and IVB GBCs were retrieved from SEER and multi-institutional dataset. Basic clinical characteristics and outcomes were recorded. Patients were staged according to the 8th edition AJCC staging system and our modified 8th edition AJCC staging system, respectively. Overall survival (OS) and cancer-specific survival (CSS) were determined by the Kaplan-Meier method. RESULTS: As defined by the 8th edition AJCC staging system, stage IVB (T1-4N2M0) GBC had better prognosis than stage IVA (T4N0-1M0) GBC. We modified the 8th edition AJCC staging system by dividing stage IVB (T1-4N2M0) GBC into two groups: modified stage IIIC (mIIIC, T1-3N2M0) and modified stage IVB (mIVB, T4N2M0). According to the modified staging system, stage mIIIC (T1-3N2M0) had better prognosis than stage IVA (T4N0-1M0) and stage mIVB (T4N2M0) had worse prognosis than stage IVA (T4N0-1M0). CONCLUSION: The SEER population-based analysis is consistent with the multi-institutional analysis, showing stage IVB (T1-4N2M0) of the 8th edition AJCC staging system is a heterogeneous group. Revising the 8th edition AJCC staging system by dividing stage IVB (T1-4N2M0) into stage mIIIC (T1-3N2M0) and stage mIVB (T4N2M0) is appropriate. It can be applied in clinical practice and will offer patients with T1-3N2M0 more treatment options. Funding: This work was supported in part by the National Natural Science Foundation of China (81101807 and 81571827), the Natural Science Foundation of Shanghai (14QA1400900), Shanghai Rising-Star Program (17QA1405600) and Shanghai Excellent Young Medical Talents Program (2017YQ006). Declaration of Interest: There are no conflicts of interest.
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