Department of Pathology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, 20 Geumo-ro, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do 50612, Republic of Korea.
Department of Pathology, Pusan National University Hospital, Pusan National University School of Medicine, 179 Gudeok-ro, Seo-gu, Busan-si 49241, Republic of Korea.
Ann Diagn Pathol. 2020 Jun;46:151489. doi: 10.1016/j.anndiagpath.2020.151489. Epub 2020 Mar 3.
According to the current 8th edition of the American Joint Committee of Cancer (AJCC), the T category of distal cholangiocarcinomas is classified based on the depth of invasion (DOI) (T1, < 5 mm; T2, between 5 and 12 mm; T3, > 12 mm). In consideration of the discrepancies between previous studies about the prognostic significance, we aimed to validate the current AJCC T staging system of distal cholangiocarcinomas. DOI was measured using three different methods: DOI1, DOI2, and DOI3. DOI1 was defined and stratified according to the AJCC 8th edition. DOI2 was measured as the distance from an imaginary curved line approximated along the distorted mucosal surface to the deepest invasive tumor cells. DOI3 was defined as the total tumor thickness. DOI2 and DOI3 were also divided into three categories using the same cut-off points as in the AJCC 8th edition. We compared these three DOI methods to the AJCC 7th edition as well. In contrast with the AJCC 7th edition, all three groups showed a correlation with patients' overall survival. Above all, the DOI2 group demonstrated the best significance in multivariate analysis. However, when the C indices were compared between these groups, differential significance proved to be negligible (DOI1 vs DOI2, p = 0.915; DOI2 vs DOI3, p = 0.057). Therefore, the measurement of DOI does not need to be rigorously and stringently performed. In conclusion, we showed that the current T classification system better correlates with the overall survival of patients with distal cholangiocarcinomas than the previous system.
根据目前的第 8 版美国癌症联合委员会（AJCC），远端胆管癌的 T 分期基于浸润深度（DOI）（T1，<5mm；T2，5-12mm 之间；T3，>12mm）进行分类。考虑到先前研究中关于预后意义的差异，我们旨在验证当前 AJCC 远端胆管癌 T 分期系统。DOI 使用三种不同的方法进行测量：DOI1、DOI2 和 DOI3。DOI1 根据 AJCC 第 8 版进行定义和分层。DOI2 定义为从沿着扭曲的黏膜表面近似的假想曲线到最深浸润肿瘤细胞的距离。DOI3 定义为肿瘤总厚度。DOI2 和 DOI3 也使用与 AJCC 第 8 版相同的截止点分为三个类别。我们还将这三种 DOI 方法与 AJCC 第 7 版进行了比较。与 AJCC 第 7 版相比，所有三组均与患者的总生存相关。最重要的是，DOI2 组在多变量分析中表现出最佳意义。然而，当比较这些组之间的 C 指数时，差异意义可以忽略不计（DOI1 与 DOI2，p=0.915；DOI2 与 DOI3，p=0.057）。因此，DOI 的测量不需要严格和严格地进行。总之，我们表明，当前的 T 分类系统与远端胆管癌患者的总生存率相关性优于以前的系统。
