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Langenbeck's Archives of Surgery

Published in:

01-08-2005 | Original Article

TNM classification for perihilar cholangiocarcinoma: comparison between 5th and 6th editions of the AJCC/UICC staging system

Authors: Hideki Nishio, Masato Nagino, Koji Oda, Tomoki Ebata, Toshiyuki Arai, Yuji Nimura

Published in: Langenbeck's Archives of Surgery | Issue 4/2005

Abstract

Background

A few investigators have evaluated the TNM classification for perihilar cholangiocarcinoma. The new sixth edition of the American Joint Committee on Cancer (AJCC)/Internal Union Against Cancer (UICC) staging system focuses on vascular invasion and regional lymph node metastasis.

Methods

For 166 patients with perihilar cholangiocarcinoma undergoing R0 resection, survival curves stratified according to TNM classifications were compared between fifth and sixth editions.

Results

The previous T3 now is divided into T3 and T4. Most new pT4 patients had invasion of the portal bifurcation; their survival was poorer than that for new pT3 patients. The 5-, 10-, and 15-year survival rates were worse in the previous stage III than in the previous stage IVA, although the difference fell short of significance. The previous stage IVA (T3AnyNM0) is divided into new stages: IIA (T3N0M0), IIB (T1-3N1M0), and III (T4AnyNM0). All patients in stage III had invasion of the portal bifurcation. Survival was similar between stages IA, IB, and IIA, while patients with T4N0M0 tumors survived longer than those with T4N1M0 tumors and similarly to those with stage IIB tumors.

Conclusions

The sixth edition provided improved prediction of survival in patients with perihilar cholangiocarcinoma; for still better prediction, cancer invasion of the portal bifurcation and regional lymph node metastasis should be weighted equally.

Pitt HA, Nakeeb A, Abrams RA, Coleman J, Piantadosi S, Yeo CJ, Lillemore KD, Cameron JL (1995) Perihilar cholangiocarcinoma: postoperative radiotherapy does not improve survival. Ann Surg 221:788–798PubMed

Nakeeb A, Pitt HA, Sohn TA, Coleman J, Abrams RA, Piantadosi S, Hruban R, Lillemore KD, Yeo CJ, Cameron JL (1996) Cholangiocarcinoma. A spectrum of intrahepatic, perihilar, and distal tumors. Ann Surg 224:463–465PubMed

Sarmiento JM, Nagorney DM (2002) Hepatic resection in the treatment of perihilar cholangiocarcinoma. Surg Oncol N Am 11:893–908

Nimura Y, Hayakawa N, Kamiya J, Kondo S, Shionoya S (1990) Hepatic segmentectomy with caudate lobe resection for bile duct carcinoma of the hepatic hilus. World J Surg 14:535–544PubMed

Nimura Y, Hayakawa N, Kamiya J, Maeda S, Kondo S, Yasui A, Shionoya S (1991) Combined portal vein and liver resection for carcinoma of the biliary tract. Br J Surg 78:727–731PubMed

Pichlmayr R, Weimann A, Klempnauer J, Oldhafer KJ, Maschek H, Tusch G, Ringe B (1996) Surgical treatment in proximal bile duct cancer. Ann Surg 224:628–638PubMed

Klempnauer J, Ridder GJ, von Wasielewski R, Werner M, Weimann A, Pichlmayr R (1997) Resectional surgery of hilar cholangiocarcinoma: a multivariate analysis of prognostic factors. J Clin Oncol 15:947–954PubMed

Kosuge T, Yamamoto J, Shimada K, Yamasaki S, Makuuchi M (1999) Improved surgical results for hilar cholangiocarcinoma with procedures including major hepatic resection. Ann Surg 230:663–671PubMed

Launois B, Terblanche J, Lakehal M, Catheline JM, Bardaxoglou E, Landen S, Campion JP, Sutherland F, Meunier B (1999) Proximal bile duct cancer: high respectability rate and 5-year survival. Ann Surg 230:266–275PubMed

10.

Neuhaus P, Jonas S, Bechstein WO, Lohmann R, Radke C, Kling N, Wex C, Lobeck H, Hintze R (1999) Extended resections for hilar cholangiocarcinoma. Ann Surg 230:808–819PubMed

11.

Nimura Y, Kamiya J, Kondo S, Nagino M, Uesaka K, Oda K, Sano T, Yamamoto H, Hayakawa N (2000) Aggressive preoperative management and extended surgery for hilar cholangiocarcinoma: Nagoya experience. J Hepatobiliary Pancreat Surg 7:155–162PubMed

12.

Lee SG, Lee YJ, Park KM, Hwang S, Min PC (2000) One hundred and eleven liver resections for hilar bile duct cancer. J Hepatobiliary Pancreat Surg 7:135–141PubMed

13.

Tsao JI, Nimura Y, Kamiya J, Hayakawa N, Kondo S, Nagino M, Miyachi M, Kanai M, Uesaka K, Oda K, Rossi RL, Braasch JW, Dugan JM (2000) Management of hilar cholangiocarcinoma. Comparison of an American and a Japanese experience. Ann Surg 232:166–174PubMed

14.

Figueras J, Llado L, Valls C, Serrano T, Ramos E, Fabregat J, Rafecas A, Torras J, Jaurrieta E (2000) Changing strategies in diagnosis and management of hilar cholangiocarcinoma. Liver Transplant 6:786–794

15.

Burke EC, Jarnagin WR, Hochwald SN, Pisters PWT, Fong Y, Blumgart LH (1998) Hilar cholangiocarcinoma. Patterns of spread, the importance of hepatic resection for curative operation, and a presurgical clinical staging system. Ann Surg 228:385–394PubMed

16.

Jarnagin WR, Fong Y, DeMatteo RP, Gonen M, Burke E, Bodniewicz J, Youssef M, Klimstra D, Blumgart LH (2001) Staging, resectability, and outcome in 225 patients with hilar cholangiocarcinoma. Ann Surg 234:507–519PubMed

17.

Sobin LH, Wittekind C (eds) (2002) TNM classification of malignant tumours, 6th edn. Wiley, New York

18.

Greene FL, Page DL, Fleming ID, Fritz AG, Balch CM, Haller DG, Morrow M (eds) (2002) AJCC cancer staging manual, 6th edn. Springer, Berlin Heidelberg New York

19.

Ebata T, Nagino M, Kamiya J, Uesaka K, Nagasaki T, Nimura Y (2003) Hepatectomy with portal vein resection for hilar cholangiocarcinoma. Ann Surg 238:720–727PubMed

20.

Sobin LH, Wittekind C (eds) (1997) TNM classification of malignant tumours, 5th edn. Wiley, New York

21.

Fleming ID, Cooper JS, Henson DE, Hutter RVP, Kennedy BJ, Murphy GP, O’Sullivan B, Sobin LH, Yarbo JW (eds) (1997) AJCC cancer staging manual, 5th edn. Lippincott-Raven, Philadelphia

22.

Su CH, Tsay SH, Wu CC, Shyr YM, King KL, Lee CH, Lui WY, Liu TJ, Peng FK (1996) Factors influencing postoperative morbidity, mortality, and survival after resection for hilar cholangiocarcinoma. Ann Surg 223:384–394PubMed

23.

Kitagawa Y, Nagino M, Kamiya J, Uesaka K, Sano T, Yamamoto H, Hayakawa N, Nimura Y (2001) Lymph node metastasis from hilar cholangiocarcinoma: audit of 110 patients who underwent regional and paraaortic node dissection. Ann Surg 233:385–392PubMed

24.

Bhuiya MR, Nimura Y, Kamiya J, Kondo S, Fukata S, Hayakawa N, Shionoya S (1992) Clinicopathological studies on perineural invasion of bile duct carcinoma. Ann Surg 215:344–349PubMed

25.

Sakamoto E, Nimura Y, Hayakawa N, Kamiya J, Kondo S, Nagino M, Kanai M, Miyachi M, Uesaka K (1998) The pattern of infiltration at the proximal border of hilar bile duct carcinoma: a histologic analysis of 62 resected cases. Ann Surg 227:405–411PubMed

26.

Nishio H, Kamiya J, Nagino M, Kanai M, Uesaka K, Sakamoto E, Fukatsu T, Nimura Y (1999) Value of percutaneous transhepatic portography before hepatectomy for hilar cholangiocarcinoma. Br J Surg 86:1415–1421PubMed

27.

Tojima Y, Nagino M, Ebata T, Uesaka K, Kamiya J, Nimura Y (2003) Immunohistochemically demonstrated lymph node micrometastasis and prognosis in patients with otherwise node-negative hilar cholangiocarcinoma. Ann Surg 237:201–207PubMed

28.

Chamberlain RS, Blumgart LH (2000) Hilar cholangiocarcinoma: a review and commentary. Ann Surg Oncol 7:55–66PubMed

29.

Nagino M, Nimura Y, Kamiya J, Kondo S, Uesaka K, Kin Y, Kutsuna Y, Hayakawa N, Yamamoto H (1995) Right or left trisegmental portal vein embolization before hepatic trisegmentectomy for hilar cholangiocarcinoma. Surgery 117:677–681PubMed

Title: TNM classification for perihilar cholangiocarcinoma: comparison between 5th and 6th editions of the AJCC/UICC staging system
Authors: Hideki Nishio
Masato Nagino
Koji Oda
Tomoki Ebata
Toshiyuki Arai
Yuji Nimura
Publication date: 01-08-2005
Publisher: Springer-Verlag
Published in: Langenbeck's Archives of Surgery / Issue 4/2005
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-005-0561-8

At a glance: The STEP trials

Springer Medicine

TNM classification for perihilar cholangiocarcinoma: comparison between 5th and 6th editions of the AJCC/UICC staging system

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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