Proposal of a new staging system for intrahepatic cholangiocarcinoma: Analysis of surgical patients from a nationwide survey of the Liver Cancer Study Group of Japan

Yoshihiro Sakamoto, Norihiro Kokudo, Yutaka Matsuyama, Michiie Sakamoto, Namiki Izumi, Masumi Kadoya, Shuichi Kaneko, Yonson Ku, Masatoshi Kudo, Tadatoshi Takayama, Osamu Nakashima

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Abstract

BACKGROUND: In the current American Joint Committee on Cancer/International Union Against Cancer staging system (seventh edition) for intrahepatic cholangiocarcinoma (ICC), tumor size was excluded, and periductal invasion was added as a new tumor classification-defining factor. The objective of the current report was to propose a new staging system for ICC that would be better for stratifying the survival of patients based on data from the nationwide Liver Cancer Study Group of Japan database. METHODS: Of 756 patients who underwent surgical resection for ICC between 2000 and 2005, multivariate analyses of the clinicopathologic factors of 419 patients who had complete data sets were performed to elucidate relevant factors for inclusion in a new tumor classification and staging system. RESULTS: Overall survival data were best stratified using a cutoff value of 2cm using a minimal P value approach to discriminate patient survival. The 5-year survival rate of 15 patients who had ICC measuring ≤2cm in greatest dimension without lymph node metastasis or vascular invasion was 100%, and this cohort was defined as T1. Multivariate analysis of prognostic factors for 267 patients with lymph node-negative and metastasis-negative (N0M0) disease indicated that the number of tumors, the presence arterial invasion, and the presence major biliary invasion were independent and significant prognostic factors. The proposed new system, which included tumor number, tumor size, arterial invasion, and major biliary invasion for tumor classification, provided good stratification of overall patient survival according to disease stage. Macroscopic periductal invasion was associated with major biliary invasion and an inferior prognosis. CONCLUSIONS: The proposed new staging system, which includes a tumor cutoff size of 2cm and major biliary invasion, may be useful for assigning patients to surgery.

Original languageEnglish
JournalCancer
DOIs
Publication statusAccepted/In press - 2015

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Keywords

  • Biliary invasion
  • Intrahepatic cholangiocarcinoma
  • Periductal invasion
  • Staging system
  • Tumor size

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Sakamoto, Y., Kokudo, N., Matsuyama, Y., Sakamoto, M., Izumi, N., Kadoya, M., Kaneko, S., Ku, Y., Kudo, M., Takayama, T., & Nakashima, O. (Accepted/In press). Proposal of a new staging system for intrahepatic cholangiocarcinoma: Analysis of surgical patients from a nationwide survey of the Liver Cancer Study Group of Japan. Cancer. https://doi.org/10.1002/cncr.29686