Stratification of Postoperative Prognosis by Invasive Tumor Thickness in Perihilar Cholangiocarcinoma
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ORIGINAL ARTICLE – HEPATOBILIARY TUMORS
Stratification of Postoperative Prognosis by Invasive Tumor Thickness in Perihilar Cholangiocarcinoma Mitsunobu Oba, MD1,2, Yoshitsugu Nakanishi, MD, PhD1, Toraji Amano, MD, PhD3, Keisuke Okamura, MD, PhD1, Takahiro Tsuchikawa, MD, PhD1, Toru Nakamura, MD, PhD1, Takehiro Noji, MD, PhD1, Toshimichi Asano, MD, PhD1, Kimitaka Tanaka, MD, PhD1, and Satoshi Hirano, MD, PhD1 1
Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan; Department of Surgical Pathology, Hokkaido University Hospital, Sapporo, Japan; 3Clinical Research and Medical Innovation Centre, Hokkaido University Hospital, Sapporo, Japan
2
ABSTRACT Background. The pathological tumor classification of distal cholangiocarcinoma in the American Joint Committee on Cancer (AJCC) Cancer Staging Manual 8th edition is based on invasive depth, whereas that of perihilar cholangiocarcinoma (PHCC) continues to be layer-based. We aimed to clarify whether invasive depth measurement based on invasive tumor thickness (ITT) could help determine postoperative prognosis in patients with PHCC. Methods. We enrolled 184 patients with PHCC who underwent hepatectomy plus extrahepatic bile duct resection or hepatopancreatoduodenectomy with curative intent. ITT was measured using simple definitions according to the sectioning direction or gross tumor pattern. Results. The median ITT was 5.8 mm (range 0.7–15.5). Using the recursive partitioning technique, ITT was classified into grades A (ITT \ 2 mm, n = 9), B (2 mm B ITT \ 5 mm, n = 68), C (5 mm B ITT \ 11 mm, n = 81), and D (11 mm \ ITT, n = 26). The median survival times (MSTs) in patients with grade B, C, or D were 90.8, 44.6, and 21.1 months, respectively (patients with grade A did not reach the MST). There were
Electronic supplementary material The online version of this article (https://doi.org/10.1245/s10434-020-09135-9) contains supplementary material, which is available to authorized users. Ó Society of Surgical Oncology 2020 First Received: 24 April 2020 Accepted: 23 August 2020 Y. Nakanishi, MD, PhD e-mail: [email protected]
significant differences in postoperative prognosis between ITT grades (A vs. B, p = 0.027; B vs. C, p \ 0.001; C vs. D, p = 0.004). Through multivariate analysis, regional node metastasis, invasive carcinoma at the resected margin, and ITT grade were determined as independent prognostic factors. Conclusion. ITT could be measured using simple methods and may be used to stratify postoperative prognosis in patients with PHCC.
Perihilar cholangiocarcinoma (PHCC) arises predominantly in the lobar extrahepatic bile ducts, distal to the segmental bile ducts and proximal to the cystic duct.1 PHCC and distal cholangiocarcinoma (DCC) were previously classified using the common TNM classification employed for extrahepatic cholangiocarcinoma, as per the American Joint Committee on Cancer (AJCC) Cancer Staging Manual, 6th edition.2 However, since the release of the 7th edition, the TNM classification of PHC
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