Annals of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회지)

The Korean Association of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회)
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Retrospective analysis of 8th edition American Joint Cancer Classification: Distal cholangiocarcinoma

  • Atish Darshan Bajracharya (Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Suniti Shrestha (Department of Pathology, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Hyung Sun Kim (Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Ji Hae Nahm (Department of Pathology, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Kwanhoon Park (Department of Surgery, National Health Insurance Service Ilsan Hospital) ;
  • Joon Seong Park (Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine)
  • Received : 2022.12.21
  • Accepted : 2023.02.14
  • Published : 2023.08.31
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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.

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References

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