Evaluation of the New American Joint Committee on Cancer Staging Manual 8th Edition for Perihilar Cholangiocarcinoma

Abstract

Background The aim was to compare the prognostic accuracy of cross-sectional imaging of the 7th and 8th editions of the American Joint Committee on Cancer(AJCC) staging system for perihilar cholangiocarcinoma(PHC). Methods All patients with PHC between 2002 and 2014 were included. Imaging at the time of presentation was reassessed and clinical tumor-node-metastasis (cTNM) stage was determined according to the 7th and 8th editions of the AJCC staging system. Comparison of the prognostic accuracy was performed using the concordance index (c-index). Results A total of 248 PHC patients were included;45 patients(18.1%) underwent a curative-intent resection, whereas 203 patients(81.9%) did not because they were unfit for surgery or were diagnosed with locally advanced or metastatic disease during workup. Prognostic accuracy was comparable between the 7th and 8th editions (c-index 0.57 vs 0.58). For patients who underwent a curative-intent resection, the prognostic accuracy of the 8th edition (0.67) was higher than the 7th (0.65). For patients who did not undergo a curative-intent resection, the prognostic accuracy was poor in both the 7th as the 8th editions (0.54 vs 0.57). Conclusion The 7th and 8th editions of the AJCC staging system for PHC have comparable prognostic accuracy. Prognostic accuracy was particularly poor in unresectable patients.

Prognostic Predictability of American Joint Committee on Cancer 8th Staging System for Perihilar Cholangiocarcinoma: Limited Improvement Compared with the 7th Staging System

“…In conclusion, the prognostic predictability of 8th AJCC staging for PHCC seems to have slightly improved, with statistical significance, over the previous edition, but the overall performance is still unsatisfactory (C-index < 0.7). Even if previous studies have shown similar results [28,29], the assessment of substantial changes in the 8th AJCC staging for PHCC remains controversial. If further studies continue to show improved results from based on the new system, we could produce a definitive conclusion on this matter, and the present study may serve as a basis for these.…”

“…They concluded 8th edition was slightly improved compared to 7th edition (C-index: 0.619, 7th; 0.624, 8th). The other from the Netherlands by Gaspersz et al [29] analyzed total of 248 patients including 45 underwent curative resection and 243 with unresectable patients. Their conclusion was both editions showed comparable prognostic accuracy (C-index: 0.57, 7th; 0.58, 8th).…”

Robotic radical surgery for hilar cholangiocarcinoma: A single‐centre case series

“…The primary tumours were classified according to the Bismuth‐Corlette classification . The definitions of the tumour stage system were based on the American Joint Committee on Cancer (AJCC) 8th edition . All patients were followed at 1 month after discharge and then at an interval of 3 months.…”

“…19 The definitions of the tumour stage system were based on the American Joint Committee on Cancer (AJCC) 8th edition. 20 All patients were followed at 1 month after discharge and then at an interval of 3 months. This study was approved by the Ethics Committee of our hospital.…”

The 8th Edition American Joint Committee on Cancer Staging for Hepato-pancreato-biliary Cancer: A Review and Update

“…The performance of the newly released 8th edition AJCC staging system in PHC, particularly the modified T category, is still unsatisfactory based on 2 European studies, 1 from the Netherlands and the other from Italy. 29,30 Further refinements were suggested. One proposal is to follow the same staging algorithm as that for the distal common bile duct, where a depth-based rather than layer-based measurement is applied to define T stage.…”