Robert J S Coelen1, Marcia P Gaspersz2, Tim A Labeur3, Jeroen L A van Vugt2, Susan van Dieren4, François E J A Willemssen5, Chung Y Nio6, Jan N M IJzermans2, Heinz-Josef Klümpen3, Bas Groot Koerkamp2, Thomas M van Gulik4. 1. Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands. Electronic address: r.j.coelen@amc.nl. 2. Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands. 3. Department of Medical Oncology, Academic Medical Center, Amsterdam, The Netherlands. 4. Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands. 5. Department of Radiology, Erasmus University Medical Center, Rotterdam, The Netherlands. 6. Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands.
Abstract
BACKGROUND & AIMS: Most systems for staging perihilar cholangiocarcinoma (PHC) have been developed for the minority of patients with resectable disease. The recently developed Mayo Clinic system for staging PHC requires only clinical and radiologic variables, but has not yet been validated. We performed a retrospective study to validate the Mayo Clinic staging system. METHODS: We identified consecutive patients with suspected PHC who were evaluated and treated at 2 tertiary centers in The Netherlands, from January 2002 through December 2014. Baseline characteristics (performance status, carbohydrate antigen 19-9 level) used in the staging system were collected from medical records and imaging parameters (tumor size, suspected vascular involvement, and metastatic disease) were reassessed by 2 experienced abdominal radiologists. Overall survival was analyzed using the Kaplan-Meier method and comparison of staging groups was performed using the log-rank test and Cox proportional hazard regression analysis. Discriminative performance was quantified by the concordance index and compared with the radiologic TNM staging of the American Joint Committee on Cancer (7th ed). RESULTS: PHCs from 600 patients were staged according to the Mayo Clinic model (23 stage I, 80 stage II, 357 stage III, and 140 stage IV). The median overall survival time was 11.6 months. The median overall survival times for patients with stages I, II, III, and IV were 33.2 months, 19.7 months, 12.1 months, and 6.0 months, respectively; with hazard ratios of 1.0 (reference), 2.02 (95% confidence interval [CI], 1.14-3.58), 2.71 (95% CI, 1.59-4.64), and 4.00 (95% CI, 2.30-6.95), respectively (P < .001). The concordance index score was 0.59 for the entire cohort (95% CI, 0.56-0.61). The Mayo Clinic model performed slightly better than the radiologic American Joint Committee on Cancer TNM system. CONCLUSIONS: In a retrospective study of 600 patients with PHC, we validated the Mayo Clinic system for staging PHC. This 4-tier staging system may aid clinicians in making treatment decisions, such as referral for surgery, and predicting survival times.
BACKGROUND & AIMS: Most systems for staging perihilar cholangiocarcinoma (PHC) have been developed for the minority of patients with resectable disease. The recently developed Mayo Clinic system for staging PHC requires only clinical and radiologic variables, but has not yet been validated. We performed a retrospective study to validate the Mayo Clinic staging system. METHODS: We identified consecutive patients with suspected PHC who were evaluated and treated at 2 tertiary centers in The Netherlands, from January 2002 through December 2014. Baseline characteristics (performance status, carbohydrate antigen 19-9 level) used in the staging system were collected from medical records and imaging parameters (tumor size, suspected vascular involvement, and metastatic disease) were reassessed by 2 experienced abdominal radiologists. Overall survival was analyzed using the Kaplan-Meier method and comparison of staging groups was performed using the log-rank test and Cox proportional hazard regression analysis. Discriminative performance was quantified by the concordance index and compared with the radiologic TNM staging of the American Joint Committee on Cancer (7th ed). RESULTS: PHCs from 600 patients were staged according to the Mayo Clinic model (23 stage I, 80 stage II, 357 stage III, and 140 stage IV). The median overall survival time was 11.6 months. The median overall survival times for patients with stages I, II, III, and IV were 33.2 months, 19.7 months, 12.1 months, and 6.0 months, respectively; with hazard ratios of 1.0 (reference), 2.02 (95% confidence interval [CI], 1.14-3.58), 2.71 (95% CI, 1.59-4.64), and 4.00 (95% CI, 2.30-6.95), respectively (P < .001). The concordance index score was 0.59 for the entire cohort (95% CI, 0.56-0.61). The Mayo Clinic model performed slightly better than the radiologic American Joint Committee on CancerTNM system. CONCLUSIONS: In a retrospective study of 600 patients with PHC, we validated the Mayo Clinic system for staging PHC. This 4-tier staging system may aid clinicians in making treatment decisions, such as referral for surgery, and predicting survival times.
Authors: Jimme K Wiggers; Bas Groot Koerkamp; David van Klaveren; Robert J Coelen; C Yung Nio; Peter J Allen; Marc G Besselink; Olivier R Busch; Michael I D'Angelica; Ronald P DeMatteo; T Peter Kingham; Thomas M van Gulik; William R Jarnagin Journal: J Am Coll Surg Date: 2018-04-06 Impact factor: 6.113
Authors: Marcia P Gaspersz; Stefan Buettner; Jeroen L A van Vugt; Jeroen de Jonge; Wojciech G Polak; Michail Doukas; Jan N M Ijzermans; Bas Groot Koerkamp; François E J A Willemssen Journal: J Gastrointest Surg Date: 2019-02-12 Impact factor: 3.452
Authors: Eva Roos; Lotte C Franken; Eline C Soer; Jeanin E van Hooft; R Bart Takkenberg; Heinz-Josef Klümpen; Johanna W Wilmink; Marc J van de Vijver; Thomas M van Gulik; Joanne Verheij Journal: Virchows Arch Date: 2019-08-24 Impact factor: 4.064