Serosal invasion in TNM staging of mass-forming intrahepatic cholangiocarcinoma

Uenishi, Takahiro; Yamazaki, Osamu; Yamamoto, Takatsugu; Hirohashi, Kazuhiro; Tanaka, Hiromu; Tanaka, Shogo; Hai, Seikan; Kubo, Shoji

doi:10.1007/s00534-005-1026-8

Cited by 52 publications

(59 citation statements)

References 29 publications

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“…However, this feature has been shown to have no survival impact and that omitting it actually improved the accuracy of staging. 27 Third, no attempt was made to further stratify Nþ patients according to the number of invaded LNs 28 or the LN ratio 29 because of the lack of standardization of LN harvesting. Finally, our strict inclusion criteria (complete clinical and pathological data sets and proven R0 resection) resulted in 69% of our patients being excluded from analysis.…”

Section: Discussionmentioning

confidence: 99%

AJCC 7th edition of TNM staging accurately discriminates outcomes of patients with resectable intrahepatic cholangiocarcinoma

Farges¹,

Fuks²,

Treut³

et al. 2010

Cancer

191

153

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BACKGROUND: This year, the 7th edition of the AJCC staging manual has for the first time attributed a unique pTNM staging to intrahepatic cholangiocarcinoma (IHCC) that is intended to replace the 2 Western and ideally also the 2 Eastern systems currently in use. This proposal, which has not yet been validated, was tested in the current study. METHODS: Among 522 patients operated on with curative intent for an IHCC between 1994 and 2008 in tertiary hepatobiliary centers, those with mass-forming-type IHCCs, an R0 resection, and accurate pathological node staging were retained for evaluation. The distribution of these patients and their actuarial survival in the new TNM stages (as well as in the 4 previous ones) were compared. RESULTS: Only 163 patients fulfilled the inclusion criteria, mainly because of the lack of routine lymphadenectomy, but patients and tumors characteristics of this population were representative. These patients were evenly distributed between AJCC 7th edition stages (stage I, 28%; stage II, 32%; stage III, 35%), which was not the case for the other systems. With an average follow-up of 34 months in survivors, the AJCC 7th edition was more discriminating than the others in predicting survival (median for stage I not reached; for stage II, 53 months, P ¼ .01; for stage III, 16 months, P < .0001). Survival of these patients according to the 2 Japanese classifications was identical to that anticipated. CONCLUSIONS: The 7th edition is clinically relevant and may be applicable worldwide, provided routine lymphadenectomy at the time of surgery for IHCC becomes the standard of care.

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Section: Discussionmentioning

confidence: 99%

AJCC 7th edition of TNM staging accurately discriminates outcomes of patients with resectable intrahepatic cholangiocarcinoma

Farges¹,

Fuks²,

Treut³

et al. 2010

Cancer

191

153

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“…The AJCC/UICC staging system is distinct from that for HCC, as the T category considers the tumor number, vascular invasion, visceral peritoneum perforation or extrahepatic direct invasion, and periductal invasion, but not the tumor size. A number of investigators have analyzed the accuracy of both staging systems in predicting patient survival after hepatic resection for ICC, and proposed some modifications based on their findings [14][15][16]47]. Farges et al [16] reported that the current AJCC/UICC staging system was the only system with good accuracy for predicting disease outcome as the other systems failed to do so, including the system proposed by the LCSGJ.…”

Section: Tnm Staging Systems and Prognostic Factorsmentioning

confidence: 99%

“…ICC often spreads via the lymphatic system and postoperative outcomes for patients with lymph node metastases are extremely poor [7][8][9][10][11][12][13][14][15][16][17][18][19][20]; however, to date no consensus among hepatic surgeons has been reached on the indications for surgical treatment of ICC with lymph node metastases and the required extent of lymph node dissection. The extent of both the resection margin and lymph node dissection can be changed by surgeons during hepatic resection for ICC, and it is therefore necessary to clarify their prognostic impact.…”

Section: Introductionmentioning

confidence: 99%

“…Recent advances in imaging technology and surgical techniques have resulted in hepatic resection for ICC being more frequently performed [5]. Nathan et al [6] reported a cumulative 34.4 % improvement in the survival of patients who underwent resection for ICC from 1992-2002, but the postoperative outcome of these patients remains unsatisfactory, as the 5-year overall survival rate after potentially curative resection is only 30-40 % [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]. ICC is asymptomatic even at advanced stages, and its associated risk factors in the population are unknown, both of which make its early detection difficult.…”

Section: Introductionmentioning

confidence: 99%

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Surgical treatment for intrahepatic cholangiocarcinoma

Uenishi

Yamamoto

Takemura

et al. 2014

Clin J Gastroenterol

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Despite surgical treatment for intrahepatic cholangiocarcinoma (ICC) becoming more widely available, the prognosis after hepatic resection for ICC remains poor. Because ICC is relatively rare, the TNM staging system for ICC was finally established in the 2000s. Resection margin status and lymph node metastases are important prognostic factors after surgery for ICC; however, the true impact of wide resection margins or lymph node dissection on postoperative survival is unclear. Although adjuvant chemotherapy can improve the postoperative prognosis of patients with various types of cancer, no standard regimen has been developed for ICC. Over 50 % of patients suffer postoperative recurrence, even after curative resection, and no effective treatment for recurrent ICC has been established. Therefore, despite advances in imaging studies and hepatobiliary surgery, significant challenges remain in improving the prognosis of patients with ICC.

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“…first reported that two cases Hepatolithiasis is merger Hepatobiliary cancer (IHHCC), the phenomenon of IHHCC aroused more and more people seriously enough, Hepatolithiasis is a common disease in China and 5% to 10% of hepatolithiasis is known to be associated with cholangiocarcinoma (Uenishi et al, 2005), However, it is difficult to detect early cholangiocarcinoma that occurs as a complication of hepatolithiasis. Clinically, IHHCC remains challenging because it is difficult to diagnose in its early stages, symptoms tend to be vague and insidious in developent, often are diagnosed at an advanced stage.…”

Section: Introductionmentioning

confidence: 99%

Diagnosis and Cure Experience of Hepatolithiasis-Associated Intrahepatic Cholangiocarcinoma in 66 Patients

Li¹,

Zhou²,

Li³

et al. 2012

Asian Pacific Journal of Cancer Prevention

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Background: The management of hepatolithiasis combined with intrahepatic cholangicarcinoma (IHHCC) remains a challenge due to poor prognosis. The aim of this study was to summarize our diagnosis and cure experience of IHHCC over the recent 10 years. Methods: From January 1996 to January 2006, 66 patients with IHHCC were reviewed retrospectively. Results: Of the 66 patients, 52 underwent surgical resection (radical resection in 38 and palliative in 14) and 8 patients abdominal exploration, while the other 6 cases received endoscopic retrograde biliary internal drainage and stent implantation. In this series, correct diagnosis of advanced stage was made during operation in 8 cases (8/60, 13.3%) and all of them (underwent unnecessary abdominal exploration, among them the positive rate of CA19-9 was 100%, and the positive rate of CEA was 87.6% (7/8), incidence rate of ascites was 100% and short-term significant weight loss was 100%, with median overall survival of only 4 months. Conclusion: Radical resection is mandatory for IHHCC patient to achieve long-term survival, the CT and MR imaging features of IHHCC being concentric enhancement. Patients with IHHCC have significant higher CA199 and significant higher CEA and short-term significant weight loss and ascites should be considered with advanced stage of IHHCC and unnecessary non-therapeutic laparotomies should be avoided.

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Serosal invasion in TNM staging of mass-forming intrahepatic cholangiocarcinoma

Cited by 52 publications

References 29 publications

AJCC 7th edition of TNM staging accurately discriminates outcomes of patients with resectable intrahepatic cholangiocarcinoma

AJCC 7th edition of TNM staging accurately discriminates outcomes of patients with resectable intrahepatic cholangiocarcinoma

Surgical treatment for intrahepatic cholangiocarcinoma

Diagnosis and Cure Experience of Hepatolithiasis-Associated Intrahepatic Cholangiocarcinoma in 66 Patients

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