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

Lee, Jong Woo; Lee, Jae Hoon; Park, Yejong; Lee, Woo Hyung; Kwon, Jae-Woo; Song, Ki Byung; Hwang, Dae Wook

doi:10.4143/crt.2020.023

Cited by 13 publications

(11 citation statements)

References 32 publications

(42 reference statements)

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“…The current literature contains only a few studies that have utilized the recent AJCC 8th edition staging system for patients and, especially, those undergoing curative liver resection for PHC at high-volume hepato-pancreato-biliary (HPB) centers [ 25 , 27 , 28 ]. In addition, there are only a few data analyzing the prognostic accuracy of the 8th TNM edition of patient prognosis in patients undergoing curative-intent liver surgery for PHC in Western centers [ 25 ].…”

Section: Introductionmentioning

confidence: 99%

Prognostic Relevance of the Eighth Edition of TNM Classification for Resected Perihilar Cholangiocarcinoma

Hau

Meyer

Jahn

et al. 2020

JCM

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Objectives: In our study, we evaluated and compared the prognostic value and performance of the 6th, 7th, and 8th editions of the American Joint Committee on Cancer (AJCC) staging system in patients undergoing surgery for perihilar cholangiocarcinoma (PHC). Methods: Patients undergoing liver surgery with curative intention for PHC between 2002 and 2019 were identified from a prospective database. Histopathological parameters and stage of the PHC were assessed according to the 6th, 7th, and 8th editions of the tumor node metastasis (TNM) classification. The prognostic accuracy between staging systems was compared using the area under the receiver operating characteristic curve (AUC) model. Results: Data for a total of 95 patients undergoing liver resection for PHC were analyzed. The median overall survival time was 21 months (95% CI 8.1–33.9), and the three- and five-year survival rates were 46.1% and 36.2%, respectively. Staging according to the 8th edition vs. the 7th edition resulted in the reclassification of 25 patients (26.3%). The log-rank p-values for the 7th and 8th editions were highly statistically significant (p ≤ 0.01) compared to the 6th edition (p = 0.035). The AJCC 8th edition staging system showed a trend to better discrimination, with an AUC of 0.69 (95% CI: 0.52–0.84) compared to 0.61 (95% CI: 0.51–0.73) for the 7th edition. Multivariate survival analysis revealed male gender, age >65 years, positive resection margins, presence of distant metastases, poorly tumor differentiation, and lymph node involvement, such as no caudate lobe resection, as independent predictors of poor survival (p < 0.05). Conclusions: In the current study, the newly released 8th edition of AJCC staging system showed no significant benefit compared to the previous 7th edition in predicting the prognosis of patients undergoing liver resection for perihilar cholangiocarcinoma. Further research may help to improve the prognostic value of the AJCC staging system for PHC—for instance, by identifying new prognostic markers or staging criteria, which may improve that individual patient’s outcome.

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Section: Introductionmentioning

confidence: 99%

Prognostic Relevance of the Eighth Edition of TNM Classification for Resected Perihilar Cholangiocarcinoma

Hau

Meyer

Jahn

et al. 2020

JCM

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“…Ruzzenente et al [38] demonstrated that the 8th edition was superior to 7th edition, with C-index of 0.624. A study from South Korea con rmed this result with C-index of 0.621 [39]. The C-index of 8th edition was 0.67 in another study from Netherlands in patients who underwent a curative-intent resection [40].…”

Section: Discussionmentioning

confidence: 73%

Development and validation of magnetic resonance imaging-based nomograms for patients with perihilar cholangiocarcinoma after radical resection: Preoperative prediction of survival

Zhao¹,

Zhang²,

Zhang³

et al. 2020

Preprint

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BackgroundSurvival status prediction for perihilar cholangiocarcinoma (pCCA) patients is essential for postoperative clinical decision making. This study aimed to develop and validate prediction models for overall survival (OS) evaluation in pCCA patients preoperatively.Materials and MethodsA total of 184 patients who had curative resection for pCCA between January 2010 and December 2018 were enrolled. 110 patients were randomly selected for model development while other 74 patients for model testing. Imaging-derived radiomics signatures were developed. Independent preoperative clinical predictors were involved independently or in combination with radiomics signatures to construct different preoperative models through multivariable Cox proportional hazards method. The nomograms were constructed to predict OS, and the performance of which was evaluated by the discrimination ability, time-dependent receiver operating characteristic curve (ROC), calibration curve and decision curve.ResultsThe clinical model (Modelclinic) was constructed based on three independent variables including preoperative CEA, cN stage and invasion of hepatic artery in images. The model with best performance (Modelclinic&AP&PVP) was build based on three independent variables, SignatureAP and SignaturePVP. In training and testing cohorts, the concordance indexes (C-indexes) of Modelclinic were 0.846 (95% CI, 0.735-0.957) and 0.755 (95% CI, 0.540-969), and Modelclinic&AP&PVP manifested favorable performance with C-indexes of 0.962 (95% CI, 0.905-1) and 0.814 (95% CI, 0.569-1), and both of them outperformed TNM staging system (C-indexes, 0.616, 95% CI, 0.522-0.711 and 0.599, 95% CI, 0.490-0.708). Good agreement was observed in the calibration curves, and favorable clinical utility was validated using the decision curve analysis both for Modelclinic and Modelclinic&AP&PVP.ConclusionsTwo preoperative nomograms were constructed to predict 1-, 3- and 5-years survival following surgery for individual pCCA patients. Such methods are easy to be performed which have clinical application potential for decision-making and patients stratification in randomized, controlled trials.

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“…We also observed that the overall predictive performance of the 8 th edition was slightly higher than that of the 7 th edition of the AJCC staging system in predicting survival of pCCA (C-index, 0.609 vs. 0.599). Similarly, Ruzzenente et al (22) demonstrated that the C-index of the 8 th edition was higher than that of the 7 th edition (0.624 vs. 0.619), and this result was confirmed by a South Korean study (C-index, 0.621 vs. 0.582) (23). Furthermore, another study from The Netherlands also demonstrated that the prognostic accuracy of the 8 th edition was higher than that of the 7 th edition (C-index, 0.67 vs. 0.65) in patients who underwent curativeintent resection (24).…”

Section: Discussionmentioning

confidence: 80%

“…The new AJCC staging system (8 th edition) for pCCA has been tested in a few centers (22)(23)(24). However, so far, no research has been conducted in China, where the incidence of pCCA is high.…”

Section: Introductionmentioning

confidence: 99%

External validation study of the 8th edition of the American Joint Committee on Cancer staging system for perihilar cholangiocarcinoma: a single-center experience in China and proposal for simplification

Zhao¹,

Zhang²,

Zhang³

et al. 2021

J Gastrointest Oncol

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Background: Several changes have been made to the primary tumor (T) and lymph node (N) categories in the new 8 th edition of the American Joint Committee on Cancer (AJCC) staging system for perihilar cholangiocarcinoma (pCCA). This study was conducted to validate the 8 th edition of the AJCC staging system for pCCA in China. Methods: A total of 335 patients who underwent curative-intent resection for pCCA between January 2010 and December 2018 were retrospectively enrolled. The overall survival (OS) of groups of patients was calculated using the Kaplan-Meier method. The log-rank test was used to compare OS between groups. The concordance index (C-index), Akaike information criteria (AIC), and time-dependent area under receiver operating characteristic (ROC) curve (AUC) were computed to evaluate the discriminatory power of the 8 th and 7 th editions of the AJCC staging system. Results: The T category changed in 25 (7.5%) patients, the N category changed in 39 (11.6%) patients, and the tumor-node-metastasis (TNM) stage changed in 157 (46.9%) patients when the 8 th and 7 th editions were compared. No statistically significant difference in survival was observed between T2aN0M0 and T2bN0M0. The C-index of the 8 th edition was 0.609 [95% confidence interval (CI): 0.568-0.650], which was slightly higher than that of the 7 th edition (C-index, 0.599, 95% CI: 0.558-0.640). The time-dependent AUC value also corroborated that the 8 th edition had a better performance than the 7 th edition. Conclusions: The 8 th edition of the AJCC staging system for pCCA showed a better ability than the 7 th edition to discriminate patient survival. However, further simplification of the 8 th edition is still needed.

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

Cited by 13 publications

References 32 publications

Prognostic Relevance of the Eighth Edition of TNM Classification for Resected Perihilar Cholangiocarcinoma

Prognostic Relevance of the Eighth Edition of TNM Classification for Resected Perihilar Cholangiocarcinoma

Development and validation of magnetic resonance imaging-based nomograms for patients with perihilar cholangiocarcinoma after radical resection: Preoperative prediction of survival

External validation study of the 8th edition of the American Joint Committee on Cancer staging system for perihilar cholangiocarcinoma: a single-center experience in China and proposal for simplification

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