Ann Hepatobiliary Pancreat Surg.  2023 Aug;27(3):251-257. 10.14701/ahbps.22-134.

Retrospective analysis of 8th edition American Joint Cancer Classification: Distal cholangiocarcinoma

• Bajracharya AD
• Shrestha S
• Kim HS
• Nahm JH
• Park K
• Park JS

• KMID: 2545718
• DOI: http://doi.org/10.14701/ahbps.22-134

Abstract

Backgrounds/Aims
This is a retrospective analysis of whether the 8th edition American Joint Committee on Cancer (AJCC) was a significant improvement over the 7th AJCC distal extrahepatic cholangiocarcinoma classification.
Methods
In total, 111 patients who underwent curative resection of mid-distal bile duct cancer from 2002 to 2019 were included. Cases were re-classified into 7th and 8th AJCC as well as clinicopathological univariate and multivariate, and Kaplan-Meier survival curve and log rank were calculated using R software.
Results
In patient characteristics, pancreaticoduodenectomy/pylorus preserving pancreaticoduodenectomy had better survival than segmental resection. Only lymphovascular invasion was found to be significant (hazard ratio 2.01, p = 0.039) among all clinicopathological variables. The 8th edition AJCC Kaplan Meier survival curve showed an inability to properly segregate stage I and IIA, while there was a large difference in survival probability between IIA and IIB.
Conclusions
The 8th distal AJCC classification did resolve the anatomical issue with the T stage, as T1 and T3 showed improvement over the 7th AJCC, and the N stage division of the N1 and N2 category was found to be justified, with poorer survival in N2 than N1.Meanwhile, in TMN staging, the 8th AJCC was able differentiate between early stage (I and IIA) and late stage (IIB and III) to better explain the patient prognosis.

Keyword

Bile duct cancer; TNM classification; Prognosis; Cholangiocarcinoma

Figure

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  Fig. 1 Kaplan-Meier survival curve according to 8th American Joint Committee on Cancer (AJCC) staging (n = 111): (A) T staging, (B) N staging, and (C) Kaplan-Meier survival staging. In the 8th Kaplan-Meier survival staging shows an intercrossing of I and IIA in 30 months onward with similar survival till 5 years with a huge gap between IIB and IIIA.

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  Fig. 2 Kaplan-Meier survival curve according to 7th American Joint Committee on Cancer (AJCC) staging (n = 111): (A) T staging, (B) N staging. (C) In the 7th Kaplan-Meier survival curve, IA and IB were closely graphed with stage III poor survival.

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