Comparison of the Sixth and the Seventh Editions of the UICC Classification for Perihilar Cholangiocarcinoma

Overview

Journal Ann Surg Oncol

Publisher Springer

Specialty Oncology

Date 2012 Jul 19

PMID 22805862

Citations 20

Authors

Benjamin Juntermanns

Georgios Charalambos Sotiropoulos

Sonia Radunz

Henning Reis

Matthias Heuer

Hideo Andreas Baba

Ali Canbay

Martin Schuler

Guido Gerken

Andreas Paul

Gernot Maximilian Kaiser

Affiliations

Soon will be listed here.

Abstract

Background: The seventh edition of the TNM classification separates extrahepatic bile duct tumors into perihilar and distal tumors and further changes the definition of the TNM classification. The impact of the seventh edition on stage-based prognostic prediction for patients with perihilar cholangiocarcinoma was evaluated.

Methods: Between January 1998 and March 2010, 223 consecutive patients with perihilar cholangiocarcinoma underwent surgery at the West German Cancer Center. Median survival times were calculated for the 195 evaluable patients (excluding those with in-hospital mortality) after separate classification by both sixth and seventh editions.

Results: Median overall survival was increased in patients classified using the seventh compared with the sixth edition (UICC I: 56.5 vs 23.75 months; II: 45.9 vs 31.6 months; III: 21.3 vs. 8.76 months; IV: 7.03 vs 5.93 months). The T category of the seventh edition did not alter median survival times of T1 (54.07 months) and T4 (7.83 months) cases, but median survival was prolonged for T2 patients (29.4 vs 31.6 months), and shortened for T3 patients (19.43 vs 11.8 months) staged using the seventh edition. According to Cox proportional hazards regression analysis, patient survival was better predicted by the seventh edition UICC stage and pT categories (p=0.0014 and p=0.0396, respectively), than the corresponding sixth edition categories (p=0.4376 and p=0.0926, respectively).

Conclusions: The UICC seventh edition TNM classification for perihilar cholangiocarcinoma improves separation of patients with intermediate stage tumors compared with the sixth edition. The prognostic value of the UICC staging system has been strengthened by the introduction of the seventh edition.

Citing Articles

Prognostic nomogram for predicting cancer-specific survival in patients with resected hilar cholangiocarcinoma: a large cohort study.

Yu Z, Liu Q, Liao H, Shi J, Zhou Z, Yan Y J Gastrointest Oncol. 2022; 13(2):833-846.

PMID: 35557567 PMC: 9086037. DOI: 10.21037/jgo-21-543.

Survival analysis of patients with stage T2a and T2b perihilar cholangiocarcinoma treated with radical resection.

Zhao J, Zhang W, Zhang J, Zhang Y, Ma W, Liu S BMC Cancer. 2020; 20(1):849.

PMID: 32883228 PMC: 7650292. DOI: 10.1186/s12885-020-07357-4.

Clinical efficacy of gemcitabine and cisplatin-based transcatheter arterial chemoembolization combined with radiotherapy in hilar cholangiocarcinoma.

Zheng W, Yu T, Luo Y, Wang Y, Liu Y, Hua X World J Gastrointest Oncol. 2019; 11(6):489-498.

PMID: 31236199 PMC: 6580316. DOI: 10.4251/wjgo.v11.i6.489.

Long-term Survival after resection for perihilar cholangiocarcinoma: Impact of UICC staging and surgical procedure.

Juntermanns B, Kaiser G, Reis H, Gries S, Kasper S, Paul A Turk J Gastroenterol. 2019; 30(5):454-460.

PMID: 31061000 PMC: 6505650. DOI: 10.5152/tjg.2019.18275.

Evaluation of the New American Joint Committee on Cancer Staging Manual 8th Edition for Perihilar Cholangiocarcinoma.

Gaspersz M, Buettner S, van Vugt J, De Jonge J, Polak W, Doukas M J Gastrointest Surg. 2019; 24(7):1612-1618.

PMID: 30756314 PMC: 7359130. DOI: 10.1007/s11605-019-04127-x.

References

Ito F, Cho C, Rikkers L, Weber S . Hilar cholangiocarcinoma: current management. Ann Surg. 2009; 250(2):210-8. DOI: 10.1097/SLA.0b013e3181afe0ab. View

Mobius C, Demuth C, Aigner T, Wiedmann M, Wittekind C, Mossner J . Evaluation of VEGF A expression and microvascular density as prognostic factors in extrahepatic cholangiocarcinoma. Eur J Surg Oncol. 2007; 33(8):1025-9. DOI: 10.1016/j.ejso.2007.02.020. View

Li J, Kuehl H, Grabellus F, Muller S, Radunz S, Antoch G . Preoperative assessment of hilar cholangiocarcinoma by dual-modality PET/CT. J Surg Oncol. 2008; 98(6):438-43. DOI: 10.1002/jso.21136. View

Kaiser G, Sotiropoulos G, Sgourakis G, Bleck J, Baba H, Beckebaumr S . Surgical treatment of Klatskin tumor: liver resection versus transplantation. Hepatogastroenterology. 2011; 57(104):1337-40. View

Rosen C, Heimbach J, Gores G . Liver transplantation for cholangiocarcinoma. Transpl Int. 2010; 23(7):692-7. DOI: 10.1111/j.1432-2277.2010.01108.x. View

Juntermanns B, Radunz S, Heuer M, Hertel S, Reis H, Neuhaus J . Tumor markers as a diagnostic key for hilar cholangiocarcinoma. Eur J Med Res. 2010; 15(8):357-61. PMC: 3458701. DOI: 10.1186/2047-783x-15-8-357. View

Schmitz K, Lang H, Kaiser G, Wohlschlaeger J, Sotiropoulos G, Baba H . Metallothionein overexpression and its prognostic relevance in intrahepatic cholangiocarcinoma and extrahepatic hilar cholangiocarcinoma (Klatskin tumors). Hum Pathol. 2009; 40(12):1706-14. DOI: 10.1016/j.humpath.2009.01.026. View

Jarnagin W, Fong Y, DeMatteo R, Gonen M, BURKE E, Bodniewicz BS J . Staging, resectability, and outcome in 225 patients with hilar cholangiocarcinoma. Ann Surg. 2001; 234(4):507-17; discussion 517-9. PMC: 1422074. DOI: 10.1097/00000658-200110000-00010. View

Nishio H, Hidalgo E, Hamady Z, Ravindra K, Kotru A, Dasgupta D . Left hepatic trisectionectomy for hepatobiliary malignancy: results and an appraisal of its current role. Ann Surg. 2005; 242(2):267-75. PMC: 1357733. DOI: 10.1097/01.sla.0000171304.70678.11. View

10.

Kaiser G, Sotiropoulos G, Jauch K, Lohe F, Hirner A, Kalff J . Liver transplantation for hilar cholangiocarcinoma: a German survey. Transplant Proc. 2008; 40(9):3191-3. DOI: 10.1016/j.transproceed.2008.08.039. View

11.

Ruys A, Busch O, Gouma D, van Gulik T . Staging laparoscopy for hilar cholangiocarcinoma: is it still worthwhile?. Ann Surg Oncol. 2011; 18(9):2647-53. PMC: 3162633. DOI: 10.1245/s10434-011-1576-8. View

12.

Fingas C, Katsounas A, Kahraman A, Siffert W, Jochum C, Gerken G . Prognostic assessment of three single-nucleotide polymorphisms (GNB3 825C>T, BCL2-938C>A, MCL1-386C>G) in extrahepatic cholangiocarcinoma. Cancer Invest. 2009; 28(5):472-8. DOI: 10.3109/07357900903095714. View

13.

Nishio H, Nagino M, Oda K, Ebata T, Arai T, Nimura Y . TNM classification for perihilar cholangiocarcinoma: comparison between 5th and 6th editions of the AJCC/UICC staging system. Langenbecks Arch Surg. 2005; 390(4):319-27. DOI: 10.1007/s00423-005-0561-8. View

14.

Ebata T, Nagino M, Kamiya J, Uesaka K, Nagasaka T, Nimura Y . Hepatectomy with portal vein resection for hilar cholangiocarcinoma: audit of 52 consecutive cases. Ann Surg. 2003; 238(5):720-7. PMC: 1356151. DOI: 10.1097/01.sla.0000094437.68038.a3. View

15.

Lang H, Sotiropoulos G, Fruhauf N, Domland M, Paul A, Kind E . Extended hepatectomy for intrahepatic cholangiocellular carcinoma (ICC): when is it worthwhile? Single center experience with 27 resections in 50 patients over a 5-year period. Ann Surg. 2004; 241(1):134-43. PMC: 1356856. DOI: 10.1097/01.sla.0000149426.08580.a1. View

16.

Tannapfel A, Wittekind C . [Anatomy and pathology of intrahepatic and extrahepatic bile duct tumors]. Pathologe. 2001; 22(2):114-23. DOI: 10.1007/s002920000416. View

17.

Juntermanns B, Kaiser G, Reis H, Saner F, Radunz S, Vernadakis S . Klatskin-mimicking lesions: still a diagnostical and therapeutical dilemma?. Hepatogastroenterology. 2011; 58(106):265-9. View

18.

Lang H, Kaiser G, Zopf T, Sotiropoulos G, Frilling A, Malago M . [Surgical therapy of hilar cholangiocarcinoma]. Chirurg. 2006; 77(4):325-34. DOI: 10.1007/s00104-006-1177-4. View