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Modified staging classification for intrahepatic cholangiocarcinoma based on the sixth and seventh editions of the AJCC/UICC TNM staging systems.

Abstract Intrahepatic cholangiocarcinoma (ICC) was differentiated from hepatocellular carcinoma, as defined in the American Joint Committee on Cancer (AJCC) 6th edition staging manual, using the revised staging system described in the AJCC 7th edition staging manual. This study was conducted to analyze the application of the AJCC 6th and 7th edition staging classifications and to evaluate a modified staging classification to potentially reduce the limitations associated with the different AJCC staging systems.We compared the prognostic value of cancer staging using data from the Surveillance, Epidemiology, and End Results database (N = 2124). The Kaplan-Meier method and Cox regression models were used to analyze survival. The Harrell concordance index (C-index) was used to analyze the discriminative abilities of cancer staging.Patients with stages I and II disease were found to have similar prognoses according to the 6th edition staging system. Using the 7th edition staging system, a low proportion of patients had stage III disease (5.0%), and the hazard ratio (HR) for stage III disease was comparable to that of stage IV disease (stage III and IV, 2.653 and 2.694). We modified the AJCC staging classification by adopting the 7th edition T, N, and M definitions and the 6th edition staging definitions. Consequently, the proportion of patients with stage III disease increased (22.8%). The HR for stage IV disease was higher than that for stage III disease (stage III and IV, 2.425 and 2.956). Meanwhile, the C-index of the modified AJCC staging system was 0.721 (95% CI: 0.696-0.745), which was significantly higher than the AJCC 7th edition staging system (0.694, P < .001), and the AJCC 6th edition staging system (0.712, P = .033). Moreover, in the stratified data, the differences between the stages identified using the modified AJCC staging classification were significant, especially among patients over 60 years in age, white patients and patients who underwent surgery.These findings suggest that the modified AJCC staging classification may be applicable to the staging of ICC and can be adopted in clinical practice.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 28834905
OWN - NLM
STAT- In-Process
DA  - 20170823
LR  - 20170823
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 96
IP  - 34
DP  - 2017 Aug
TI  - Modified staging classification for intrahepatic cholangiocarcinoma based on the 
      sixth and seventh editions of the AJCC/UICC TNM staging systems.
PG  - e7891
LID - 10.1097/MD.0000000000007891 [doi]
AB  - Intrahepatic cholangiocarcinoma (ICC) was differentiated from hepatocellular
      carcinoma, as defined in the American Joint Committee on Cancer (AJCC) 6th
      edition staging manual, using the revised staging system described in the AJCC
      7th edition staging manual. This study was conducted to analyze the application
      of the AJCC 6th and 7th edition staging classifications and to evaluate a
      modified staging classification to potentially reduce the limitations associated 
      with the different AJCC staging systems.We compared the prognostic value of
      cancer staging using data from the Surveillance, Epidemiology, and End Results
      database (N = 2124). The Kaplan-Meier method and Cox regression models were used 
      to analyze survival. The Harrell concordance index (C-index) was used to analyze 
      the discriminative abilities of cancer staging.Patients with stages I and II
      disease were found to have similar prognoses according to the 6th edition staging
      system. Using the 7th edition staging system, a low proportion of patients had
      stage III disease (5.0%), and the hazard ratio (HR) for stage III disease was
      comparable to that of stage IV disease (stage III and IV, 2.653 and 2.694). We
      modified the AJCC staging classification by adopting the 7th edition T, N, and M 
      definitions and the 6th edition staging definitions. Consequently, the proportion
      of patients with stage III disease increased (22.8%). The HR for stage IV disease
      was higher than that for stage III disease (stage III and IV, 2.425 and 2.956).
      Meanwhile, the C-index of the modified AJCC staging system was 0.721 (95% CI:
      0.696-0.745), which was significantly higher than the AJCC 7th edition staging
      system (0.694, P &lt; .001), and the AJCC 6th edition staging system (0.712, P =
      .033). Moreover, in the stratified data, the differences between the stages
      identified using the modified AJCC staging classification were significant,
      especially among patients over 60 years in age, white patients and patients who
      underwent surgery.These findings suggest that the modified AJCC staging
      classification may be applicable to the staging of ICC and can be adopted in
      clinical practice.
FAU - Meng, Ze-Wu
AU  - Meng ZW
AD  - aDepartment of Hepatobiliary Surgery, Fujian Medical University Union Hospital
      bKey Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian
      Medical University, Fuzhou, Fujian, People's Republic of China.
FAU - Pan, Wei
AU  - Pan W
FAU - Hong, Hai-Jie
AU  - Hong HJ
FAU - Chen, Jiang-Zhi
AU  - Chen JZ
FAU - Chen, Yan-Ling
AU  - Chen YL
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
EDAT- 2017/08/24 06:00
MHDA- 2017/08/24 06:00
CRDT- 2017/08/24 06:00
AID - 10.1097/MD.0000000000007891 [doi]
AID - 00005792-201708250-00042 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2017 Aug;96(34):e7891. doi: 10.1097/MD.0000000000007891.