Validation of the 8th Edition of the American Joint Committee on Cancer Staging System for Gallbladder Cancer and Implications for the Follow-up of Patients without Node Dissection

Abstract

Original ArticlePurpose The 8th edition of gallbladder cancer staging in the American Joint Committee on Cancer (AJCC) staging system changed the T and N categories. Materials and MethodsIn order to validate the new staging system, a total of 348 surgically resected gallbladder cancers were grouped based on the 8th edition of the T and N categories and compared with patients' survival. ResultsSignificant differences were noted between T1b-T2a (p=0.003) and T2b-T3 (p < 0.001) tumors, but not between Tis-T1a, T1a-T1b, and T2a-T2b tumors. However, significant survival differences were observed both by the overall and pair-wise (T1-T2, T2-T3) comparisons (all, p < 0.001) without dividing T1/T2 subcategories. When cases with ! 6 examined lymph nodes were evaluated, significant survival differences were observed among the entire comparison (p < 0.001) and pair-wise comparisons of N0-N1 (p=0.001) and N1-N2 (p=0.039) lesions. When cases without nodal dissection (NX) were additionally compared, significant survival differences were observed between patients with N0-NX (p=0.001) and NX-N1 (p < 0.001) lesions. ConclusionThe T category in the 8th edition of the AJCC staging system did not completely stratify the prognosis of patients with gallbladder cancer. Modification by eliminating T subcategories can better stratify the prognosis. In contrast, the N category clearly determines patients' survival with ! 6 examined lymph nodes. The survival time in patients of gallbladder cancers without nodal dissection is between N0 and N1 cases. Therefore, close postoperative followed up is recommended for those patients.

Prognostic Significance of Tumor Location in T2 Gallbladder Cancer: A Systematic Review and Meta-Analysis

“…Of these, 1782 studies were discharged because it appeared that these studies were not of interest after reviewing the title and abstracts. The full texts of the remaining nine studies were reviewed in detail and two studies were excluded for the following reasons: did not report interest of outcomes [ 17 , 18 ].…”

High Systemic Inflammation Response Index (SIRI) Indicates Poor Outcome in Gallbladder Cancer Patients with Surgical Resection: A Single Institution Experience in China

“…For many decades, physicians have been devoted to making more precise predictions of outcome for patients with GBC. To date, the TNM staging system, which was proposed by the American Joint Committee on Cancer (AJCC), remains the gold standard in cancer management [ 5 ]. However, other factors such as patients’ demographic features, symptoms, and laboratory test data may also have important effects on the prognosis of GBC patients, which will lead to great divergence in clinical outcome even in patients at the same TNM stage.…”

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

“…44 Yet, there are mixed opinions in other studies, especially for the T category. 45,46 Some proposed potential modifications including further dividing T3 into T3a (tumors penetrating serosa but not directly invading liver and/or an adjacent organ or structure) and T3b (tumor penetrating serosa and directly invading liver and/or an adjacent organ or structure). 45 The number-based N category appears to be prognostic if 6 or more lymph nodes are available for examination.…”