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American Joint Committee on Cancer staging for resected perihilar cholangiocarcinoma: a comparison of the 6th and 7th editions.
[cholangiocarcinoma]
This
study
was
conducted
to
evaluate
the
prognostic
value
of
,
respectively
,
the
6
th
and
7
th
editions
of
the
American
Joint
Committee
on
Cancer
(
AJCC
)
staging
system
for
patients
with
resected
perihilar
cholangiocarcinoma
(
PHC
)
.
Patients
who
underwent
resection
of
PHC
between
1991
and
2012
were
identified
from
prospective
databases
at
two
centres
.
Overall
survival
was
estimated
using
the
Kaplan-
Meier
method
and
compared
across
stage
groups
with
the
log-rank
test
.
The
concordance
index
and
Brier
score
were
used
to
compare
the
prognostic
accuracy
of
the
staging
systems
.
Data
for
a
total
of
306
patients
were
analysed
.
Staging
according
to
the
7
th
edition
upstaged
63
%
of
patients
in
comparison
with
staging
by
the
6
th
edition
.
The
log-rank
P-
value
for
both
staging
systems
was
highly
statistically
significant
(
P
<
0
.
001
)
.
Staging
according
to
the
6
th
edition
categorized
93
%
of
patients
as
having
stage
I
or
II
disease
,
whereas
staging
according
to
the
7
th
edition
distributed
patients
more
equally
across
stages
.
Prognostic
accuracy
was
similar
between
the
staging
systems
:
the
concordance
index
was
0
.
59
and
the
Brier
score
0
.
17
for
both
the
6
th
and
7
th
editions
.
The
same
prognostic
accuracy
was
achieved
using
an
alternative
tumour-node-metastasis
(
TNM
)
stage
grouping
simplified
to
four
rather
than
six
stage
groups
.
The
6
th
and
7
th
editions
of
the
AJCC
staging
system
for
PHC
have
similar
prognostic
accuracy
.
Other
prognostic
factors
can
potentially
improve
individual
patient
prognostication
.
