Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Pathology and Clinical Laboratories, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Br J Surg. 2019 Mar;106(4):427-435. doi: 10.1002/bjs.11063. Epub 2019 Jan 24.
The T system for distal cholangiocarcinoma has been revised from a layer-based to a depth-based approach in the current American Joint Committee on Cancer (AJCC) classification. In perihilar cholangiocarcinoma, tumour depth in the staging scheme has not yet been addressed. The aim of this study was to propose a new T system using measured tumour depth in perihilar cholangiocarcinoma.
Patients who underwent hepatectomy for perihilar cholangiocarcinoma between 2001 and 2014 were reviewed retrospectively. The vertical distance between the top of the tumour and deepest invasive cells was measured as invasive tumour thickness (ITT) by two independent pathologists. Log rank statistics were used to determine cut-off points, and the concordance (C) index was used to assess survival discrimination of each T system.
ITT was measurable in all 440 patients, with a median value of 6·0 (range 0-45) mm. The median difference in ITT between observers was 0·6 (range 0-20) mm. Cut-off points for prognosis were 1, 5 and 8 mm. Five-year survival decreased with increasing ITT (P < 0·001): 67 per cent for ITT less than 1 mm (25 patients), 54·9 per cent for ITT 1 mm and over to less than 5 mm (138 patients), 43·4 per cent for ITT 5 mm and over to less than 8 mm (118 patients), and 32·2 per cent for ITT 8 mm and over (159 patients). The C-index of this classification was comparable to that of the current AJCC T classification (0·598 versus 0·589).
ITT is a reliable approach for making a depth assessment in perihilar cholangiocarcinoma. A four-tier ITT classification with cut-off points of 1, 5 and 8 mm is an adequate alternative to the current layer-based T classification.
当前的美国癌症联合委员会（AJCC）分类系统已将远端胆管癌的 T 系统从基于层次的方法修订为基于深度的方法。在肝门部胆管癌中，分期方案中尚未涉及肿瘤深度。本研究旨在提出一种新的 T 系统，用于测量肝门部胆管癌的肿瘤深度。
回顾性分析 2001 年至 2014 年间接受肝切除术治疗的肝门部胆管癌患者。由两位独立的病理学家测量肿瘤顶部与最深侵袭细胞之间的垂直距离作为侵袭性肿瘤厚度（ITT）。对数秩检验用于确定截断值，C 指数用于评估每个 T 系统的生存判别能力。
440 例患者的 ITT 均可测量，中位数为 6.0（范围 0-45）mm。观察者之间 ITT 的中位数差值为 0.6（范围 0-20）mm。预后的截断值为 1、5 和 8mm。随着 ITT 的增加，五年生存率降低（P<0.001）：ITT<1mm 的患者为 67%（25 例），ITT 为 1mm 及以上至<5mm 的患者为 54.9%（138 例），ITT 为 5mm 及以上至<8mm 的患者为 43.4%（118 例），ITT 为 8mm 及以上的患者为 32.2%（159 例）。该分类的 C 指数与现行 AJCC T 分类相当（0.598 比 0.589）。
ITT 是评估肝门部胆管癌深度的可靠方法。采用 1、5 和 8mm 截断值的四分层 ITT 分类是对现行基于层次 T 分类的一个充分替代。
