Gaya Spolverato1, Fabio Bagante1, Matthew Weiss2, Sorin Alexandrescu3, Hugo P Marques4, Luca Aldrighetti5, Shishir K Maithel6, Carlo Pulitano7, Todd W Bauer8, Feng Shen9, George A Poultsides10, Oliver Soubrane11, Guillaume Martel12, Bas Groot Koerkamp13, Alfredo Guglielmi1, Endo Itaru14, Timothy M Pawlik15. 1. Department of Surgery, University of Verona, Verona, Italy. 2. Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland. 3. Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania. 4. Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal. 5. Department of Surgery, Ospedale San Raffaele, Milan, Italy. 6. Department of Surgery, Emory University, Atlanta, Georgia. 7. Department of Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia. 8. Department of Surgery, University of Virginia, Charlottesville, Virginia. 9. Department of Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai, China. 10. Department of Surgery, Stanford University, Stanford, California. 11. Department of Hepatobiliopancreatic Surgery and Liver Transplantation, AP-HP, Beaujon Hospital, Clichy, France. 12. Division of General Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada. 13. Department of Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands. 14. Division of Gastroenterological Surgery, Yokohama City University School of Medicine, Yokohama, Japan. 15. Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
Abstract
BACKGROUND: We sought to evaluate and validate the 8th edition of the AJCC classification using a multi-institutional cohort of patients with intrahepatic cholangiocarcinoma (ICC). METHODS: Patients undergoing curative-intent hepatic resection for ICC between 1990 and 2015 at 14 major hepatobiliary centers were included and were staged according to 7th and 8th editions AJCC criteria. RESULTS: A total of 1154 patients underwent liver resection for ICC. When patients were staged using the AJCC 7th edition, T2a, T2b, and T4 patients had a higher hazard ratio (HR) of death compared with T1 (T2a, HR 1.43, P = 0.004; T2b, HR 1.99, P < 0.001; T4, HR 2.20, P < 0.001). T3 patients had a higher HR of death compared with T1 patients (HR 1.30, P = 0.029) but lower than T2a and T2b. According to AJCC 8th edition, T1b, T2, and T4 patients were at higher risk of death compared with T1a patients (T1b, HR 1.91, P < 0.001; T2, HR 2.29, P < 0.001; T4, HR 4.16, P < 0.001). As in the AJCC 7th edition, AJCC 8th edition T3 patients had a higher HR of death compared with T1 patients (HR 1.65, P = 0.001) but lower than T1b and T2. AJCC 8th edition. T-category performed slightly better than AJCC 7th edition with a C-index of 0.609 versus 0.590. CONCLUSIONS: A staging system that perfectly discriminates between stages has not yet been developed, but the AJCC 8th edition was able to better stratify the risk of death of Stage III and T3 patients.
BACKGROUND: We sought to evaluate and validate the 8th edition of the AJCC classification using a multi-institutional cohort of patients with intrahepatic cholangiocarcinoma (ICC). METHODS:Patients undergoing curative-intent hepatic resection for ICC between 1990 and 2015 at 14 major hepatobiliary centers were included and were staged according to 7th and 8th editions AJCC criteria. RESULTS: A total of 1154 patients underwent liver resection for ICC. When patients were staged using the AJCC 7th edition, T2a, T2b, and T4 patients had a higher hazard ratio (HR) of death compared with T1 (T2a, HR 1.43, P = 0.004; T2b, HR 1.99, P < 0.001; T4, HR 2.20, P < 0.001). T3 patients had a higher HR of death compared with T1 patients (HR 1.30, P = 0.029) but lower than T2a and T2b. According to AJCC 8th edition, T1b, T2, and T4 patients were at higher risk of death compared with T1a patients (T1b, HR 1.91, P < 0.001; T2, HR 2.29, P < 0.001; T4, HR 4.16, P < 0.001). As in the AJCC 7th edition, AJCC 8th edition T3 patients had a higher HR of death compared with T1 patients (HR 1.65, P = 0.001) but lower than T1b and T2. AJCC 8th edition. T-category performed slightly better than AJCC 7th edition with a C-index of 0.609 versus 0.590. CONCLUSIONS: A staging system that perfectly discriminates between stages has not yet been developed, but the AJCC 8th edition was able to better stratify the risk of death of Stage III and T3 patients.
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