Tamura Shunsuke, Yamamoto Yusuke, Sugiura Teiichi, Okamura Yukiyasu, Ito Takaaki, Ashida Ryo, Ohgi Katsuhisa, Sasaki Keiko, Sugino Takashi, Uesaka Katsuhiko
Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Japan.
Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Japan.
HPB (Oxford). 2021 Aug;23(8):1209-1216. doi: 10.1016/j.hpb.2020.12.001. Epub 2020 Dec 19.
BACKGROUND: The 7th and 8th editions of the American Joint Committee on Cancer (AJCC) tumor (T) classification of distal cholangiocarcinoma (DCC), which are based on either layer or depth, may not accurately stratify patient survival. METHODS: A total of 121 patients who underwent resection for DCC between 2002 and 2016 were analyzed. The impact of the AJCC staging system on survival was examined and a new T classification was established based on independent prognostic factors. RESULTS: Regarding overall survival, the optimal depth of invasion (DOI) cut-off value (8 mm) was the only independent prognostic factor. Regarding the relapse-free survival (RFS), a DOI >8 mm, portal vein (PV) invasion, and duodenal or pancreatic invasion were independent prognostic factors. A new T classification was developed as follows: T1, no invasion of adjacent organs; T2, invasion of the duodenum or pancreas; T3, invasion >8 mm into the bile duct wall; and T4, invasion of the PV or arteries. There were no significant differences in RFS according to the 8th edition of the AJCC. However, significant differences were observed in the RFS between T1 and T2 and between T2 and T3. CONCLUSION: A new T classification based on the layer and depth may be more feasible.
J Hepatobiliary Pancreat Sci. 2018-4