Survival analysis of patients with stage T2a and T2b perihilar cholangiocarcinoma treated with radical resection
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RESEARCH ARTICLE
Open Access
Survival analysis of patients with stage T2a and T2b perihilar cholangiocarcinoma treated with radical resection Jian Zhao1,2†, Wei Zhang1,2†, Jun Zhang1, Yi Zhang2, Wen-Jie Ma3, Si-Yun Liu4, Fu-Yu Li3† and Bin Song1*†
Abstract Background: Both the 7th and 8th editions of the American Joint Committee on Cancer (AJCC) staging system for perihilar cholangiocarcinoma (pCCA) had the same definition for T2a and T2b. But the value of this classification as prognostic factor remains unclear. Methods: 178 patients with stage T2a or T2b who underwent curative intent resection for pCCA between Jan 2010 and Dec 2018 were enrolled. Relationships between survival and clinicopathological factors including patient demographics and tumor characteristics were evaluated using univariate and multivariate Cox regression analysis. The overall survival (OS) were calculated by Kaplan-Meier method. Results: There was no significant difference in OS between T2a and T2b groups, and the median OS duration were 37 and 31 months (P = 0.354). Both the 7th and 8th edition of the AJCC TNM staging demonstrated a poor prognostic predictive performance. High level of preoperative AST (≥85.0 IU/L) and CA19–9 (≥1000 U/mL), vascular resection and lower pathological differentiation of the tumor were the independent predictors for poor survival after resection. Conclusion: The newly released 8th edition of AJCC staging system demonstrated a poor ability to discriminate the prognosis of patients with stage T2a and T2b pCCA after resection. Keywords: Perihilar cholangiocarcinoma, AJCC, Prognosis, Overall survival, Curative intent resection
Background Cholangiocarcinoma (CCA) is one of the most challenging diseases in hepatobiliary surgery field [1, 2]. CCA is a lethal epithelial malignancy of the bile duct and often presents with locally advanced or metastatic disease [3– 5]. The median survival for advanced cholangiocarcinoma was less than 12 months [6]. The incidence of CCA in the U.S. continued to rise in the past 40 years [7]. In Asia, the incidence of hepatobiliary cancers was * Correspondence: [email protected] Fu-Yu Li and Bin Song contribute equally to this work. † Jian Zhao and Wei Zhang should be considered joint first author. 1 Department of Radiology, West China Hospital, Sichuan University, No.37 Guoxue Alley, Wuhou District, Chengdu City 610041, Sichuan Province, P.R. China Full list of author information is available at the end of the article
also high [8]. Because of the perihilar and distal cholangiocarcinoma had distinct epidemiology, biologic behavior, prognosis and management, the 7th edition of the American Joint Committee on Cancer (AJCC) staging system, published in 2009, further separated extrahepatic cholangiocarcinoma into two groups by either perihilar (proximal) or distal cholangiocarcinoma [9]. Therefore, the CCA have been classified into three groups anatomically: intrahepatic cholangiocarcinoma (iCCA), perihilar cholangiocarcinoma (pCCA) and distal cholangiocarcinoma (dCCA) [3, 10]. M
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