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A random Abstract
Our Project
Our Team
A New Clinically Based Staging System for Perihilar Cholangiocarcinoma.
[cholangiocarcinoma]
OBJECTIVES
:
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
.
METHODS
:
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
)
7
th
tumor
-node-metastasis
(
TNM
)
staging
system
.
RESULTS
:
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
.
CONCLUSIONS
:
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
.
Am
J
Gastroenterol
advance
online
publication
,
11
November
2014
;
doi
:
10
.
1038
/
ajg
.
2014
.
327
.
Diseases
Validation
Diseases presenting
"oncology"
symptom
adrenal incidentaloma
alexander disease
aromatase deficiency
carcinoma of the gallbladder
cholangiocarcinoma
coats disease
cowden syndrome
cutaneous mastocytosis
erdheim-chester disease
esophageal carcinoma
heparin-induced thrombocytopenia
hirschsprung disease
hodgkin lymphoma, classical
oral submucous fibrosis
proteus syndrome
systemic capillary leak syndrome
This symptom has already been validated