Proposal for a new classification for perihilar cholangiocarcinoma based on tumour depth
| Autor: | Masato Nakaguro, Masato Nagino, Kentaro Shinohara, Yoshie Shimoyama, Keitaro Matsuo, Takashi Mizuno, Tomoki Ebata |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Male Databases Factual Concordance medicine.medical_treatment 030230 surgery Disease-Free Survival Statistics Nonparametric Cohort Studies 03 medical and health sciences 0302 clinical medicine Biopsy medicine Hepatectomy Humans Perihilar Cholangiocarcinoma Societies Medical Survival analysis Aged Retrospective Studies T classification medicine.diagnostic_test business.industry Biopsy Needle Retrospective cohort study Middle Aged Prognosis Immunohistochemistry Survival Analysis United States Log-rank test Treatment Outcome Bile Duct Neoplasms 030220 oncology & carcinogenesis Female Surgery Neoplasm Grading Nuclear medicine business Klatskin Tumor |
| Zdroj: | British Journal of Surgery. 106:427-435 |
| ISSN: | 1365-2168 0007-1323 |
| DOI: | 10.1002/bjs.11063 |
| Popis: | Background The T system for distal cholangiocarcinoma has been revised from a layer-based to a depth-based approach in the current American Joint Committee on Cancer (AJCC) classification. In perihilar cholangiocarcinoma, tumour depth in the staging scheme has not yet been addressed. The aim of this study was to propose a new T system using measured tumour depth in perihilar cholangiocarcinoma. Methods Patients who underwent hepatectomy for perihilar cholangiocarcinoma between 2001 and 2014 were reviewed retrospectively. The vertical distance between the top of the tumour and deepest invasive cells was measured as invasive tumour thickness (ITT) by two independent pathologists. Log rank statistics were used to determine cut-off points, and the concordance (C) index was used to assess survival discrimination of each T system. Results ITT was measurable in all 440 patients, with a median value of 6·0 (range 0–45) mm. The median difference in ITT between observers was 0·6 (range 0–20) mm. Cut-off points for prognosis were 1, 5 and 8 mm. Five-year survival decreased with increasing ITT (P < 0·001): 67 per cent for ITT less than 1 mm (25 patients), 54·9 per cent for ITT 1 mm and over to less than 5 mm (138 patients), 43·4 per cent for ITT 5 mm and over to less than 8 mm (118 patients), and 32·2 per cent for ITT 8 mm and over (159 patients). The C-index of this classification was comparable to that of the current AJCC T classification (0·598 versus 0·589). Conclusion ITT is a reliable approach for making a depth assessment in perihilar cholangiocarcinoma. A four-tier ITT classification with cut-off points of 1, 5 and 8 mm is an adequate alternative to the current layer-based T classification. |
| Databáze: | OpenAIRE |
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