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A Proposed Staging System for Intrahepatic Cholangiocarcinoma

  • Hepatobiliary and Pancreatic Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

The American Joint Committee on Cancer (AJCC)/International Union Against Cancer (UICC) staging system for liver cancer is based on data exclusively derived from hepatocellular carcinoma (HCC) patients and thus may be inappropriate for patients with intrahepatic cholangiocarcinoma (ICC). We sought to empirically derive an ICC staging system from population-based data on patients with ICC. The Surveillance, Epidemiology, and End Results (SEER) database was used to identify 598 patients who underwent surgery for ICC between 1988 and 2004. The discriminative abilities of the AJCC/UICC liver cancer and two Japanese ICC staging systems were evaluated. Independent predictors of survival were identified using Cox proportional hazards models. A staging system for ICC was then derived based on these analyses. The AJCC/UICC T classification system failed to adequately stratify the T2 and T3 cohorts due to tumor size >5 cm not being a relevant prognostic factor [hazard ratio (HR) 0.97, 95% confidence interval (CI) 0.72–1.30]. In contrast, presence of multiple lesions (HR 1.42, 95% CI 1.01–2.01) or vascular invasion (HR 1.53, 95% CI 1.10–2.12) predicted adverse prognosis. Based on these findings, an ICC staging system was developed that omits tumor size. This system showed no loss of prognostic discrimination compared with the AJCC/UICC system and significant superiority over the Japanese systems. We conclude that the AJCC/UICC liver cancer staging system fails to stratify ICC patients adequately and inappropriately includes tumor size. We propose a staging system specifically developed for ICC based on number of tumors, vascular invasion, lymph node status, and presence of metastatic disease.

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Acknowledgements

The authors would like to thank Marta M. Gilson of the Department of Surgery, The Johns Hopkins University School of Medicine, for her review of the statistical analyses presented in this manuscript. Dr. Nathan and Dr. Pawlik are supported by grant number 1KL2RR025006-01 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official view of NCRR or NIH.

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Authors and Affiliations

  1. Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Hari Nathan, Richard D. Schulick, Michael A. Choti & Timothy M. Pawlik

  2. Department of Surgery, The Methodist Hospital, Houston, TX, USA

    Thomas A. Aloia

  3. Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA

    Jean-Nicolas Vauthey & Eddie K. Abdalla

  4. Department of Hematology-Oncology, Massachusetts General Hospital Cancer Center, Boston, MA, USA

    Andrew X. Zhu

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  1. Hari Nathan
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Correspondence to Timothy M. Pawlik.

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Nathan, H., Aloia, T.A., Vauthey, JN. et al. A Proposed Staging System for Intrahepatic Cholangiocarcinoma. Ann Surg Oncol 16, 14–22 (2009). https://doi.org/10.1245/s10434-008-0180-z

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  • DOI: https://doi.org/10.1245/s10434-008-0180-z

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