Abstract
The 8th American Joint Committee on Cancer (AJCC) staging system for distal cholangiocarcinoma (DCC) included a positive lymph node count (PLNC), but a comparison of the prognostic predictive power of PLNC and lymph node ratio (LNR) is still under debate. This study aimed to compare various staging models made by combining the abovementioned factors, identify the model with the best predictive power, and propose a modified staging system. We retrospectively reviewed 251 patients who underwent surgery for DCC at four centers. To determine the superiority of various staging models for predicting overall OSR, Akaike information criterion (AIC), Bayesian information criterion (BIC), AIC correction (AICc), and Harrell’s C-statistic were calculated. In multivariate analysis, age (p = 0.003), total lymph node count (p = 0.033), and revised T(LNR)M staging (p < 0.001) were identified as independent factors for overall survival rate. The predictive performance of revised T (LNR) M staging (AIC: 1288.925, BIC: 1303.377, AICc: 1291.52, and Harrell’s C statics: 0.667) was superior to other staging system. A modified staging system consisting of revised T category and LNR predicted better overall survival of DCC than AJCC 7th and AJCC 8th editions. In the future, external validation of the proposed new system using a larger cohort will be required.
Highlights
Cholangiocarcinoma (CCC) is a malignant disease that occurs along the biliary tract and is known to constitute 3% of all gastrointestinal cancers [1]
The median value of the tumor invasion depth was 6.0 (0.2–25.0) mm, and T3 was observed in 28 patients (11.9%) in the American Joint Committee on Cancer (AJCC) 8th T category, stratified according to the tumor depth
In the 7th AJCC classification, 78 patients were classified as N1
Summary
Cholangiocarcinoma (CCC) is a malignant disease that occurs along the biliary tract and is known to constitute 3% of all gastrointestinal cancers [1]. Joint Committee on Cancer (AJCC) TNM classification is widely used as a staging system to predict this dismal prognosis of the disease. The T category was categorized, using objective figures expressed as the depth of invasion (DOI) [6], which was defined as the distance from the basal lamina of the adjacent normal epithelium to the deepest infiltrating tumor cells. Applying this definition, the T category is subdivided as follows: T1
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