A New Clinically Based Staging System for Perihilar Cholangiocarcinoma

Current staging systems for perihilar cholangiocarcinoma (pCCA) are inadequate, as they are based on surgical pathology and therefore not relevant to unresectable patients. Clinical trials for potential targeted therapies for pCCA are hampered by the lack of an accurate, nonoperative staging system...

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Veröffentlicht in:The American journal of gastroenterology Jg. 109; H. 12; S. 1881 - 1890
Hauptverfasser: Chaiteerakij, Roongruedee, Harmsen, William S, Marrero, Carlos Romero, Aboelsoud, Mohammed M., Ndzengue, Albert, Kaiya, Joseph, Therneau, Terry M, Sanchez, William, Gores, Gregory J, Roberts, Lewis R
Format: Journal Article
Sprache:Englisch
Veröffentlicht: United States Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins 01.12.2014
Schlagworte:
Adult
Aged
Aged, 80 and over
Bile Duct Neoplasms - blood
Bile Duct Neoplasms - pathology
Bile Ducts, Intrahepatic - pathology
CA-19-9 Antigen - blood
Cholangiocarcinoma - blood
Cholangiocarcinoma - pathology
Cohort Studies
Cystic Duct - pathology
Female
Gastroenterology
Hepatic Duct, Common - pathology
Humans
Lymph Nodes - pathology
Male
Middle Aged
Neoplasm Metastasis
Neoplasm Staging
Proportional Hazards Models
Retrospective Studies
Tumor Burden
Young Adult
ISSN:0002-9270, 1572-0241, 1572-0241
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Zusammenfassung:Current staging systems for perihilar cholangiocarcinoma (pCCA) are inadequate, as they are based on surgical pathology and therefore not relevant to unresectable patients. Clinical trials for potential targeted therapies for pCCA are hampered by the lack of an accurate, nonoperative staging system for predicting survival. We aimed at developing a clinical staging system for pCCA, which would be of prognostic relevance for all pCCA patients and help stratify patients for clinical trials. Clinical information at the time of pCCA diagnosis of 413 patients seen at Mayo Clinic, Rochester, MN between 2002 and 2010 was retrospectively analyzed. A survival predictive model was developed using Cox proportional hazards analysis. The performance of the staging system was compared with the current AJCC/UICC (the American Joint Committee on Cancer/the Union for International Cancer Control) 7th tumor-node-metastasis (TNM) staging system. Eastern Cooperative Oncology Group (ECOG) status, tumor size and number, vascular encasement, lymph node and peritoneal metastasis and CA 19-9 level were grouped into a four-tier staging system. The median survivals of stages I, II, III, and IV patients were 48.6, 21.8, 8.6, and 2.8 months, with hazard ratios (95% confidence interval) of 1.0 (reference), 1.7 (1.1-2.6), 3.1 (2.0-4.7), and 8.7 (5.2-14.5), respectively (P<0.0001). This staging system had greater concordance statistics (standard error) than the TNM staging system (0.725 (0.018) vs. 0.614 (0.017)), indicating better performance in predicting survival. This staging system, based on nonoperative information at the time of pCCA diagnosis, has excellent discriminatory power to classify patients into four prognostic stages. It could be useful to clinicians and for the design of clinical trials.
Bibliographie:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
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ISSN:0002-9270
1572-0241
1572-0241
DOI:10.1038/ajg.2014.327