Cancer Res Treat.  2019 Jan;51(1):98-111. 10.4143/crt.2017.595.

Validation of the Eighth American Joint Committee on Cancer Staging System for Distal Bile Duct Carcinoma

• Jun SY
• Sung YN
• Lee JH
• Park KM
• Lee YJ
• Hong SM

• KMID: 2437603
• DOI: http://doi.org/10.4143/crt.2017.595

Abstract

PURPOSE
T category of the eighth edition of the American Joint Committee on Cancer (AJCC) staging system for distal bile duct carcinoma (DBDC) was changed to include tumor invasion depth measurement, while the N category adopted a 3-tier classification system based on the number of metastatic nodes.
MATERIALS AND METHODS
To validate cancer staging, a total of 200 surgically resected DBDCs were staged and compared according to the seventh and eighth editions.
RESULTS
T categories included T1 (n=37, 18.5%), T2 (n=114, 57.0%), and T3 (n=49, 24.5%). N categories included N0 (n=133, 66.5%), N1 (n=50, 25.0%), and N2 (n=17, 8.5%). Stage groupings included I (n=33, 16.5%), II (n=150, 75.0%), and III (n=17, 8.5%). The overall 5-year survival rates (5-YSRs) of T1, T2, and T3 were 59.3%, 42.4%, and 12.2%, respectively. T category could discriminate patient survival by both pairwise (T1 and T2, p=0.011; T2 and T3, p < 0.001) and overall (p < 0.001) comparisons. The overall 5-YSRs of N0, N1, and N2 were 47.3%, 17.0%, and 14.7%, respectively. N category could partly discriminate patient survival by both pairwise (N0 and N1, p < 0.001; N1 and N2, p=0.579) and overall (p < 0.001) comparisons. The overall 5-YSRs of stages I, II, and III were 59.0%, 35.4%, and 14.7%, respectively. Stages could distinguish patient survival by both pairwise (I and II, p=0.002; II and III, p=0.015) and overall (p < 0.001) comparisons. On multivariate analyses, T and N categories (p=0.014 and p=0.029) and pancreatic invasion (p=0.006) remained significant prognostic factors.
CONCLUSION
The T andNcategories of the eighth edition AJCC staging system for DBDC accurately predict patient prognosis.

Keyword

Bile duct; Extrahepatic; Cholangiocarcinoma; Neoplasm; Staging

MeSH Terms

Bile Ducts*
Bile*
Cholangiocarcinoma
Classification
Humans
Joints*
Multivariate Analysis
Neoplasm Staging*
Prognosis
Survival Rate

Figure

• 

  Fig. 1. Schematic drawing of the distal bile duct (BD).

• 

  Fig. 2. Overall survival stratified by T and N categories of distal bile duct carcinomas according to the American Joint Committee on Cancer. T categories of the eighth edition (A) and the seventh edition (B) and N categories of the eighth edition (C) and the seventh edition (D).

• 

  Fig. 3. Overall survival stratified by stage group of distal bile duct carcinomas according to the American Joint Committee on Cancer eighth edition (A and B) and seventh edition stage grouping (C and D).

• 

  Fig. 4. Overall survival stratified by size-based criteria of distal bile duct carcinomas (DBDCs). All DBDCs (A), including intra-pancreatic, extra-pancreatic, and both intra- and extra-pancreatic types. Intra-pancreatic (B) and extra-pancreatic (C) DBDCs.

• 

  Fig. 5. Overall survival stratified by number of metastatic lymph nodes.

Reference

References

1. Gonzalez RS, Bagci P, Basturk O, Reid MD, Balci S, Knight JH, et al. Intrapancreatic distal common bile duct carcinoma: analysis, staging considerations, and comparison with pancreatic ductal and ampullary adenocarcinomas. Mod Pathol. 2016; 29:1358–69.

2. Shin HR, Oh JK, Masuyer E, Curado MP, Bouvard V, Fang Y, et al. Comparison of incidence of intrahepatic and extrahepatic cholangiocarcinoma: focus on East and South-Eastern Asia. Asian Pac J Cancer Prev. 2010; 11:1159–66.

3. Albores-Saavedra J, Adsay NV, Crawford JM, Klimstra DS, Kloppel G, Sripa B, et al. Tumours of the gallbladder and extrahepatic bile ducts. In : Bosman FT, Carneiro F, Hruban RH, Theise ND, editors. WHO classification of tumours of digestive system. 4th ed. Lyon: IARC Press;2010. p. 266–73.

4. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin. 2015; 65:5–29.

5. Beahrs OH, Henson DE, Hutter RV, Kennedy BJ. American Joint Committee in Cancer. Manual for staging of cancer. 4th ed. Philadenphia, PA: J.B. Lippincott Company;1992.

6. Fleming ID, Cooper JS, Henson DE, Hutter RV, Kennedy BJ, Murphy GP, et al. AJCC cancer staging manual. 5th ed. Philadelphia, PA: Lippincott-Raven;1997.

7. Hong SM, Kim MJ, Pi DY, Jo D, Cho HJ, Yu E, et al. Analysis of extrahepatic bile duct carcinomas according to the New American Joint Committee on Cancer staging system focused on tumor classification problems in 222 patients. Cancer. 2005; 104:802–10.

8. Hong SM, Presley AE, Stelow EB, Frierson HF Jr, Moskaluk CA. Reconsideration of the histologic definitions used in the pathologic staging of extrahepatic bile duct carcinoma. Am J Surg Pathol. 2006; 30:744–9.

9. Hong SM, Pawlik TM, Cho H, Aggarwal B, Goggins M, Hruban RH, et al. Depth of tumor invasion better predicts prognosis than the current American Joint Committee on Cancer T classification for distal bile duct carcinoma. Surgery. 2009; 146:250–7.

10. Edge SB, Byrd DR, Campton CC, Fritz AG, Greene FL, Trotti A. AJCC cancer staging manual. 7th ed. New York: Springer-Verlag;2010.

11. Greene FL, Page DL, Fleming ID, Fritz AG, Balch CM, Haller DG, et al. AJCC cancer staging manual. 6th ed. New York: Springer-Verlag;2002.

12. Hong SM, Cho H, Moskaluk CA, Yu E. Measurement of the invasion depth of extrahepatic bile duct carcinoma: an alternative method overcoming the current T classification problems of the AJCC staging system. Am J Surg Pathol. 2007; 31:199–206.

13. Moon A, Choi DW, Choi SH, Heo JS, Jang KT. Validation of T stage according to depth of invasion and N stage subclassification based on number of metastatic lymph nodes for distal extrahepatic bile duct (EBD) carcinoma. Medicine (Baltimore). 2015; 94:e2064.

14. Edge SB, Greene FL, Schilsky RL, Gaspar LE, Washington MK, Sullivan DC, et al. AJCC cancer staging manual. 8th ed. Basel: Springer Nature;2017.

15. Yoshida T, Aramaki M, Bandoh T, Kawano K, Sasaki A, Matsumoto T, et al. Para-aortic lymph node metastasis in carcinoma of the distal bile duct. Hepatogastroenterology. 1998; 45:2388–91.

16. Yoshida T, Aramaki M, Matsumoto T, Morii Y, Sasaki A, Kitano S. The pattern of lymphatic spread in carcinoma of the distal bile duct. Int Surg. 1998; 83:124–7.

17. Yoshida T, Shibata K, Yokoyama H, Morii Y, Matsumoto T, Sasaki A, et al. Patterns of lymph node metastasis in carcinoma of the distal bile duct. Hepatogastroenterology. 1999; 46:1595–8.

18. Yoshida T, Matsumoto T, Sasaki A, Morii Y, Aramaki M, Kitano S. Prognostic factors after pancreatoduodenectomy with extended lymphadenectomy for distal bile duct cancer. Arch Surg. 2002; 137:69–73.

19. Yoshida T, Matsumoto T, Sasaki A, Morii Y, Shibata K, Ishio T, et al. Lymphatic spread differs according to tumor location in extrahepatic bile duct cancer. Hepatogastroenterology. 2003; 50:17–20.

20. Yoshida T, Matsumoto T, Sasaki A, Shibata K, Aramaki M, Kitano S. Outcome of paraaortic node-positive pancreatic head and bile duct adenocarcinoma. Am J Surg. 2004; 187:736–40.

21. Schwarz RE, Smith DD. Lymph node dissection impact on staging and survival of extrahepatic cholangiocarcinomas, based on U.S. population data. J Gastrointest Surg. 2007; 11:158–65.

22. Hong SM, Cho H, Lee OJ, Ro JY. The number of metastatic lymph nodes in extrahepatic bile duct carcinoma as a prognostic factor. Am J Surg Pathol. 2005; 29:1177–83.

23. Kiriyama M, Ebata T, Aoba T, Kaneoka Y, Arai T, Shimizu Y, et al. Prognostic impact of lymph node metastasis in distal cholangiocarcinoma. Br J Surg. 2015; 102:399–406.

24. Hamilton SR, Bosman FT, Boffetta P, Ilyas M, Morreau H, Nakamura SI, et al. Carcinoma of the colon and rectum. In : Bosman FT, Carneiro F, Hruban RH, Theise ND, editors. WHO classification of tumours of the digestive system. 4th ed. Lyon: IARC Press;2010. p. 134–46.

25. Kang JS, Lee S, Son D, Han Y, Lee KB, Kim JR, et al. Prognostic predictability of the new American Joint Committee on Cancer 8th staging system for distal bile duct cancer: limited usefulness compared with the 7th staging system. J Hepatobiliary Pancreat Sci. 2018; 25:124–30.