Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Division of Molecular and Clinical Epidemiology, Aichi Cancer Center Research Institute, Nagoya, Japan.
J Hepatobiliary Pancreat Sci. 2022 Jul;29(7):768-777. doi: 10.1002/jhbp.1066. Epub 2021 Nov 9.
Clinical tumor staging is essential information for making a therapeutic decision in cancer. This study aimed to identify the optimal tumor classification system for predicting resectability and survival probability in perihilar cholangiocarcinoma.
Patients who were treated for perihilar cholangiocarcinoma between 2009 and 2018 were enrolled. Local tumor extension was staged radiologically according to a diameter-based classification system in addition to the AJCC, Blumgart, and Bismuth systems. Survival and resectability were compared between T subgroups, and the discriminability of the four systems was assessed with Harrell's concordance index (C-index).
Among 702 study patients, 559 (80.0%) underwent laparotomy, 489 (70.0%) of whom underwent resection. The resectability significantly decreased for more advanced tumors in all systems (P < .001); the AJCC system had the greatest discriminability for resectability (area under the curve 0.721). Overall survival at 5 years was 69.9% for AJCC cT1, 45.8% for cT2, 31.8% for cT3, and 15.3% for cT4 tumors (cT1 vs cT2; P = .002, cT2 vs cT3; P = .008 and cT3 vs cT4; P < .001). The AJCC system had the largest C-index of 0.627.
The AJCC T system was the optimal classification system for predicting resectability and survival in perihilar cholangiocarcinoma.
临床肿瘤分期是制定癌症治疗决策的重要信息。本研究旨在确定最佳的肿瘤分类系统，以预测肝门部胆管癌的可切除性和生存概率。
纳入 2009 年至 2018 年间接受肝门部胆管癌治疗的患者。根据基于直径的分类系统对局部肿瘤进行影像学分期，除了 AJCC、Blumgart 和 Bismuth 系统外。比较 T 亚组之间的生存和可切除性，并使用 Harrell 一致性指数（C 指数）评估四个系统的区分能力。
在 702 例研究患者中，559 例（80.0%）接受了剖腹手术，其中 489 例（70.0%）接受了切除术。在所有系统中，进展期肿瘤的可切除性显著降低（P<0.001）；AJCC 系统对可切除性的区分能力最强（曲线下面积 0.721）。AJCC cT1 组的 5 年总生存率为 69.9%，cT2 组为 45.8%，cT3 组为 31.8%，cT4 组为 15.3%（cT1 与 cT2；P=0.002，cT2 与 cT3；P=0.008，cT3 与 cT4；P<0.001）。AJCC 系统的 C 指数最大，为 0.627。
AJCC T 系统是预测肝门部胆管癌可切除性和生存的最佳分类系统。
