Faculty Collaboration Database

Proposal for a new T-stage classification system for distal cholangiocarcinoma: a 10-institution study from the U.S. Extrahepatic Biliary Malignancy Consortium. HPB (Oxford) 2016 Oct;18(10):793-799

Date

08/11/2016

Pubmed ID

27506989

Pubmed Central ID

PMC5061021

DOI

10.1016/j.hpb.2016.07.009

Scopus ID

2-s2.0-84992700454 (requires institutional sign-in at Scopus site)   19 Citations

Abstract

BACKGROUND: 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.

METHODS: 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.

RESULTS: 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: size <3 cm and (-)LVI (n = 69; 39.2%); T2: size ≥3 cm and (-)LVI or size <3 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).

CONCLUSION: 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.

Author List

Postlewait LM, Ethun CG, Le N, Pawlik TM, Buettner S, Poultsides G, Tran T, Idrees K, Isom CA, Fields RC, Krasnick B, Weber SM, Salem A, Martin RCG, Scoggins C, Shen P, Mogal HD, Schmidt C, Beal E, Hatzaras I, Vitiello G, Cardona K, Maithel SK

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Aged, 80 and over
Bile Duct Neoplasms
Cholangiocarcinoma
Female
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Multivariate Analysis
Neoplasm Invasiveness
Neoplasm Staging
Pancreaticoduodenectomy
Proportional Hazards Models
Retrospective Studies
Risk Factors
Time Factors
Treatment Outcome
Tumor Burden
United States