Department of Surgery, University of Tsukuba, Graduate School of Comprehensive Human Sciences, 1-1-1, Tennodai, Tsukuba, 305-8575, Japan.
Langenbecks Arch Surg. 2010 Aug;395(6):615-23. doi: 10.1007/s00423-010-0640-3. Epub 2010 Apr 1.
Two staging systems exist to classify extrahepatic cholangiocarcinoma (EHC), the TNM staging of the International Union Against Cancer (UICC) and the classification system of the Japanese Society of Biliary Surgery (JSBS). This study sought to evaluate the utility of these two staging systems.
One hundred and twenty eight consecutive patients who underwent surgical resection were retrospectively classified into the appropriate stages using the UICC-TNM and JSBS systems. We also compared the distribution and survival curves of respective stages.
Although the UICC-TNM staging system divided patients into seven categories, 106 of 128 patients (82.8%) fell into three stages (stages IA, IIA, or IIB). In contrast, patients were relatively evenly divided across the five categories in JSBS staging. The survival curve of UICC-TNM stage IIB was more similar to stage IV than stages IIA or III; survival rates for stages IIB and IV were significantly lower than the other stages. According to the JSBS staging system, there were significant differences between stages I and III, IVA and IVB, and II and IVA/IVB, and III and IVA/IVB.
Patients who underwent surgical resection were not evenly divided across UICC-TNM staging categories in comparison to JSBS staging. Stratification of survival ability was better when using the JSBS staging in comparison to the UICC-TNM system. The better understanding about distribution of patient classified by stage and stratification ability of survival of these two staging system may help surgeons assess the patients with EHC.
存在两种用于分类肝外胆管癌（EHC）的分期系统，即国际抗癌联盟（UICC）的 TNM 分期和日本胆道外科学会（JSBS）的分类系统。本研究旨在评估这两种分期系统的实用性。
回顾性地将 128 例接受手术切除的连续患者分别归入 UICC-TNM 和 JSBS 系统的适当分期。我们还比较了各分期的分布和生存曲线。
尽管 UICC-TNM 分期系统将患者分为 7 类，但 128 例患者中有 106 例（82.8%）归入 3 个分期（IA、IIA 或 IIB）。相比之下，JSBS 分期中患者相对均匀地分布在 5 个分期中。UICC-TNM 分期 IIB 的生存曲线与 IV 期更相似，而不是 IIA 或 III 期；IIB 和 IV 期的生存率明显低于其他分期。根据 JSBS 分期系统，I 期和 III 期、IVA 和 IVB 期以及 II 期和 IVA/IVB 期之间存在显著差异，III 期和 IVA/IVB 期之间也存在显著差异。
与 JSBS 分期相比，接受手术切除的患者在 UICC-TNM 分期类别中分布不均匀。与 UICC-TNM 系统相比，使用 JSBS 分期对生存能力进行分层的效果更好。更好地了解按分期分类的患者的分布情况和这两种分期系统的生存分层能力，可能有助于外科医生评估 EHC 患者。
