1. Proposal for a new T-stage classification system for distal cholangiocarcinoma: a 10-institution study from the U.S. Extrahepatic Biliary Malignancy Consortium☆
- Author
-
Nina Le, Charles R. Scoggins, Shishir K. Maithel, Gerardo A. Vitiello, Ahmed Salem, Stefan Buettner, Perry Shen, Bradley A. Krasnick, Timothy M. Pawlik, Robert C.G. Martin, Ryan C. Fields, Chelsea A. Isom, George A. Poultsides, Sharon M. Weber, Ioannis Hatzaras, Kamran Idrees, Kenneth Cardona, Eliza W. Beal, Carl Schmidt, Thuy B. Tran, Cecilia G. Ethun, Lauren M. Postlewait, and Harveshp Mogal
- Subjects
Adult ,Male ,medicine.medical_specialty ,Time Factors ,Lymphovascular invasion ,Kaplan-Meier Estimate ,030230 surgery ,Gastroenterology ,Resection ,Pancreaticoduodenectomy ,Biliary malignancy ,Cholangiocarcinoma ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Medicine ,Humans ,Neoplasm Invasiveness ,Staging system ,Aged ,Neoplasm Staging ,Proportional Hazards Models ,Retrospective Studies ,Aged, 80 and over ,Hepatology ,Tumor size ,business.industry ,Proportional hazards model ,Retrospective cohort study ,Middle Aged ,United States ,Tumor Burden ,Treatment Outcome ,Bile Duct Neoplasms ,030220 oncology & carcinogenesis ,Multivariate Analysis ,T-stage ,Original Article ,Female ,Radiology ,business - Abstract
Seventh AJCC distal cholangiocarcinoma T-stage classification inadequately separates patients by survival. This retrospective study aimed to define a novel T-stage system to better stratify patients after resection.Curative-intent pancreaticoduodenectomies for distal cholangiocarcinoma (1/2000-5/2015) at 10 US institutions were included. Relationships between tumor characteristics and overall survival (OS) were assessed and incorporated into a novel T-stage classification.176 patients (median follow-up: 24mo) were included. Current AJCC T-stage was not associated with OS (T1: 23mo, T2: 20mo, T3: 25mo, T4: 12mo; p = 0.355). Tumor size ≥3 cm and presence of lymphovascular invasion (LVI) were associated with decreased OS on univariate and multivariable analyses. Patients were stratified into 3 groups [T1: size3 cm and (-)LVI (n = 69; 39.2%); T2: size ≥3 cm and (-)LVI or size3 cm and (+)LVI (n = 82; 46.6%); and T3: size ≥3 cm and (+)LVI (n = 25; 14.2%)]. Each progressive proposed T-stage was associated with decreased median OS (T1: 35mo; T2: 20mo; T3: 8mo; p = 0.002).Current AJCC distal cholangiocarcinoma T-stage does not adequately stratify patients by survival. This proposed T-stage classification, based on tumor size and LVI, better differentiates patient outcomes after resection and could be considered for incorporation into the next AJCC distal cholangiocarcinoma staging system.
- Published
- 2016