Depth of tumor invasion better predicts prognosis than the current American Joint Committee on Cancer T classification for distal bile duct carcinoma

Abstract

Background The American Joint Committee on Cancer (AJCC) T classification system for cholangiocarcinoma does not take into account the unique pathologic features of the bile duct. As such, the current AJCC T classification for distal cholangiocarcinoma may be inaccurate. Methods A total of 147 patients with distal cholangiocarcinoma were identified from a single institution database. The prognostic importance of depth of tumor invasion relative to the AJCC T classification system was assessed. Results The AJCC T classification was T1 (n = 11, 7.5%), T2 (n = 6, 4.1%), T3 (n = 73, 49.7%), or T4 (n = 57, 38.8%). When cases were analyzed according to depth of tumor invasion, most lesions were ≥5 mm (<5 mm, 9.5%; range, 5–12, 51.0%; >12 mm, 39.5%). The AJCC T classification was not associated with survival outcome (median survival, T1, 40.1 months; T2, 14.8 months; T3, 16.5 months; T4, 20.2 months; P = .17). In contrast, depth of tumor invasion was associated with a worse outcome as tumor depth increased (median survival, <5 mm, not reached; range, 5–12, 28.9 months; >12 mm, 12.9 months; P = .001). On multivariate analyses, tumor depth remained the factor most associated with outcome (<5 mm; hazard ratio [HR] = referent vs 5–12 mm; HR = 3.8 vs >12 mm; HR = 6.7 mm; P = .001). Conclusion The AJCC T classification for distal cholangiocarcinoma does not accurately predict prognosis. Depth of the bile duct carcinoma invasion is a better alternative method to determine prognosis and should be incorporated into the pathologic assessment of resected distal cholangiocarcinoma.

Preoperative Neutrophil-to-Lymphocyte Ratio for Prognostication of Patients with Distal Bile Duct Carcinomas Undergoing Surgery

“…The reported 5-year survival of patients with DBC has ranged from 18 to 47% [14,34,35,36,37]. These low survival rates are mainly attributable to invasion of veins, lymph nodes, or nerve tissue at the time of resection [14,38].…”

A case of distal extrahepatic cholangiocarcinoma with two positive resection margins

“…According to the 8th edition of the Union for International Cancer Control-American Joint Committee on Cancer (UICC-AJCC) classification there are two divisions of extrahepatic cholangiocarcinoma-distal and perihilar. For distal extrahepatic CCA, tumor depth invasion, number of lymph node metastases, perineural, microscopic vascular invasion, R0 resection and pancreatic invasion are reported to be predictors of long term survival (16)(17)(18)(19)(20)(21)(22)(23). A single positive bile duct resection margin is usually correlated with increased risk of recurrence and poor prognosis, as is a positive lymph node (24,25).…”

Comprehensive management of cholangiocarcinoma: Part I. Diagnosis

“…Perineural and vascular invasion are other important prognostic factors. 35 Tumor size < 2 cm, high degree of tumor differentiation, R0 resection and negative LN involvement have been shown as markers of favorable survival. The study of 56 patients with equally distributed well-, moderate and poorly differentiated DCC demonstrated 5-year survival rate of 43% (median, 24.5 months).…”