Modification of the eighth AJCC/UICC staging system for perihilar cholangiocarcinoma: An alternative pathological staging system from cholangiocarcinoma-prevalent Northeast Thailand
AimThis study aims to improve the classification performance of the eighth American Joint Committee on Cancer (AJCC) staging system for perihilar cholangiocarcinoma (pCCA) by proposing the Khon Kaen University (KKU) staging system developed in cholangiocarcinoma-prevalent Northeast Thailand.MethodFo...
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Frontiers Media S.A.
2022-09-01
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Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2022.893252/full |
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author | Chaiwat Aphivatanasiri Chaiwat Aphivatanasiri Chaiwat Aphivatanasiri Prakasit Sa-Ngiamwibool Prakasit Sa-Ngiamwibool Prakasit Sa-Ngiamwibool Sakkarn Sangkhamanon Sakkarn Sangkhamanon Sakkarn Sangkhamanon Piyapharom Intarawichian Piyapharom Intarawichian Piyapharom Intarawichian Waritta Kunprom Waritta Kunprom Waritta Kunprom Malinee Thanee Malinee Thanee Malinee Thanee Piya Prajumwongs Piya Prajumwongs Piya Prajumwongs Narong Khuntikeo Narong Khuntikeo Narong Khuntikeo Attapol Titapun Attapol Titapun Attapol Titapun Apiwat Jareanrat Apiwat Jareanrat Apiwat Jareanrat Vasin Thanasukarn Vasin Thanasukarn Vasin Thanasukarn Tharatip Srisuk Tharatip Srisuk Tharatip Srisuk Vor Luvira Vor Luvira Vor Luvira Kulyada Eurboonyanun Kulyada Eurboonyanun Kulyada Eurboonyanun Julaluck Promsorn Julaluck Promsorn Julaluck Promsorn Watcharin Loilome Watcharin Loilome Watcharin Loilome Aileen Wee Supinda Koonmee Supinda Koonmee Supinda Koonmee |
author_facet | Chaiwat Aphivatanasiri Chaiwat Aphivatanasiri Chaiwat Aphivatanasiri Prakasit Sa-Ngiamwibool Prakasit Sa-Ngiamwibool Prakasit Sa-Ngiamwibool Sakkarn Sangkhamanon Sakkarn Sangkhamanon Sakkarn Sangkhamanon Piyapharom Intarawichian Piyapharom Intarawichian Piyapharom Intarawichian Waritta Kunprom Waritta Kunprom Waritta Kunprom Malinee Thanee Malinee Thanee Malinee Thanee Piya Prajumwongs Piya Prajumwongs Piya Prajumwongs Narong Khuntikeo Narong Khuntikeo Narong Khuntikeo Attapol Titapun Attapol Titapun Attapol Titapun Apiwat Jareanrat Apiwat Jareanrat Apiwat Jareanrat Vasin Thanasukarn Vasin Thanasukarn Vasin Thanasukarn Tharatip Srisuk Tharatip Srisuk Tharatip Srisuk Vor Luvira Vor Luvira Vor Luvira Kulyada Eurboonyanun Kulyada Eurboonyanun Kulyada Eurboonyanun Julaluck Promsorn Julaluck Promsorn Julaluck Promsorn Watcharin Loilome Watcharin Loilome Watcharin Loilome Aileen Wee Supinda Koonmee Supinda Koonmee Supinda Koonmee |
author_sort | Chaiwat Aphivatanasiri |
collection | DOAJ |
description | AimThis study aims to improve the classification performance of the eighth American Joint Committee on Cancer (AJCC) staging system for perihilar cholangiocarcinoma (pCCA) by proposing the Khon Kaen University (KKU) staging system developed in cholangiocarcinoma-prevalent Northeast Thailand.MethodFour hundred eighty-eight patients with pCCA who underwent partial hepatectomy between 2002 and 2017 at the Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand, were included. Overall survival (OS) related to clinicopathological features was analyzed using the Kaplan–Meier method. Logrank test was performed in univariate analysis to compare OS data of clinicopathological features to determine risk factors for poor survival. Significant features were further analyzed by multivariate analysis (Cox regression) to identify prognostic factors which were then employed to modify the eighth AJCC staging system.ResultsMultivariate analysis showed that growth pattern (HR = 4.67–19.72, p < 0.001), moderately and poorly differentiated histological grades (HR = 2.31–4.99, p < 0.05 and 0.001, respectively), lymph node metastasis N1 and N2 (HR = 1.37 and 2.18, p < 0.05 and 0.01, respectively), and distant metastasis (HR = 2.11, p < 0.001) were independent factors when compared to their respective reference groups. There was a clear separation of patients with pCCA into KKU stage: I [OS = 116 months (mo.)], II (OS = 46 mo.), IIIA (OS = 24 mo.), IIIB (11 mo.), IVA (OS = 7 mo.), and IVB (OS = 6 mo.).ConclusionThe new staging system was based on the incorporation of growth patterns to modify the eighth AJCC staging system. The classification performance demonstrated that the KKU staging system was able to classify and distinctly separate patients with pCCA into those with good and poor outcomes. It was also able to improve the stratification performance and discriminative ability of different stages of pCCA classification better than the eighth AJCC staging system. Hence, the KKU staging system is proposed as an alternative model to augment the accuracy of survival prognostication and treatment performance for patients with pCCA. |
first_indexed | 2024-04-11T10:39:02Z |
format | Article |
id | doaj.art-7ed45ac1a01f45a7b87310e088facf7d |
institution | Directory Open Access Journal |
issn | 2296-858X |
language | English |
last_indexed | 2024-04-11T10:39:02Z |
publishDate | 2022-09-01 |
publisher | Frontiers Media S.A. |
record_format | Article |
series | Frontiers in Medicine |
spelling | doaj.art-7ed45ac1a01f45a7b87310e088facf7d2022-12-22T04:29:14ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2022-09-01910.3389/fmed.2022.893252893252Modification of the eighth AJCC/UICC staging system for perihilar cholangiocarcinoma: An alternative pathological staging system from cholangiocarcinoma-prevalent Northeast ThailandChaiwat Aphivatanasiri0Chaiwat Aphivatanasiri1Chaiwat Aphivatanasiri2Prakasit Sa-Ngiamwibool3Prakasit Sa-Ngiamwibool4Prakasit Sa-Ngiamwibool5Sakkarn Sangkhamanon6Sakkarn Sangkhamanon7Sakkarn Sangkhamanon8Piyapharom Intarawichian9Piyapharom Intarawichian10Piyapharom Intarawichian11Waritta Kunprom12Waritta Kunprom13Waritta Kunprom14Malinee Thanee15Malinee Thanee16Malinee Thanee17Piya Prajumwongs18Piya Prajumwongs19Piya Prajumwongs20Narong Khuntikeo21Narong Khuntikeo22Narong Khuntikeo23Attapol Titapun24Attapol Titapun25Attapol Titapun26Apiwat Jareanrat27Apiwat Jareanrat28Apiwat Jareanrat29Vasin Thanasukarn30Vasin Thanasukarn31Vasin Thanasukarn32Tharatip Srisuk33Tharatip Srisuk34Tharatip Srisuk35Vor Luvira36Vor Luvira37Vor Luvira38Kulyada Eurboonyanun39Kulyada Eurboonyanun40Kulyada Eurboonyanun41Julaluck Promsorn42Julaluck Promsorn43Julaluck Promsorn44Watcharin Loilome45Watcharin Loilome46Watcharin Loilome47Aileen Wee48Supinda Koonmee49Supinda Koonmee50Supinda Koonmee51Cholangiocarcinoma Screening and Care Program (CASCAP), Khon Kaen University, Khon Kaen, ThailandCholangiocarcinoma Research Institute, Khon Kaen University, Khon Kaen, ThailandDepartment of Pathology, Faculty of Medicine, Khon Kaen University, Khon Kaen, ThailandCholangiocarcinoma Screening and Care Program (CASCAP), Khon Kaen University, Khon Kaen, ThailandCholangiocarcinoma Research Institute, Khon Kaen University, Khon Kaen, ThailandDepartment of Pathology, Faculty of Medicine, Khon Kaen University, Khon Kaen, ThailandCholangiocarcinoma Screening and Care Program (CASCAP), Khon Kaen University, Khon Kaen, ThailandCholangiocarcinoma Research Institute, Khon Kaen University, Khon Kaen, ThailandDepartment of Pathology, Faculty of Medicine, Khon Kaen University, Khon Kaen, ThailandCholangiocarcinoma Screening and Care Program (CASCAP), Khon Kaen University, Khon Kaen, ThailandCholangiocarcinoma Research Institute, Khon Kaen University, Khon Kaen, ThailandDepartment of Pathology, Faculty of Medicine, Khon Kaen University, Khon Kaen, ThailandCholangiocarcinoma Screening and Care Program (CASCAP), Khon Kaen University, Khon Kaen, ThailandCholangiocarcinoma Research Institute, Khon Kaen University, Khon Kaen, ThailandDepartment of Pathology, Faculty of Medicine, Khon Kaen University, Khon Kaen, ThailandCholangiocarcinoma Screening and Care Program (CASCAP), Khon Kaen University, Khon Kaen, ThailandCholangiocarcinoma Research Institute, Khon Kaen University, Khon Kaen, ThailandDepartment of Pathology, Faculty of Medicine, Khon Kaen University, Khon Kaen, ThailandCholangiocarcinoma Screening and Care Program (CASCAP), Khon Kaen University, Khon Kaen, ThailandCholangiocarcinoma Research Institute, Khon Kaen University, Khon Kaen, ThailandDepartment of Pathology, Faculty of Medicine, Khon Kaen University, Khon Kaen, ThailandCholangiocarcinoma Screening and Care Program (CASCAP), Khon Kaen University, Khon Kaen, ThailandCholangiocarcinoma Research Institute, Khon Kaen University, Khon Kaen, ThailandDepartment of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, ThailandCholangiocarcinoma Screening and Care Program (CASCAP), Khon Kaen University, Khon Kaen, ThailandCholangiocarcinoma Research Institute, Khon Kaen University, Khon Kaen, ThailandDepartment of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, ThailandCholangiocarcinoma Screening and Care Program (CASCAP), Khon Kaen University, Khon Kaen, ThailandCholangiocarcinoma Research Institute, Khon Kaen University, Khon Kaen, ThailandDepartment of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, ThailandCholangiocarcinoma Screening and Care Program (CASCAP), Khon Kaen University, Khon Kaen, ThailandCholangiocarcinoma Research Institute, Khon Kaen University, Khon Kaen, ThailandDepartment of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, ThailandCholangiocarcinoma Screening and Care Program (CASCAP), Khon Kaen University, Khon Kaen, ThailandCholangiocarcinoma Research Institute, Khon Kaen University, Khon Kaen, ThailandDepartment of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, ThailandCholangiocarcinoma Screening and Care Program (CASCAP), Khon Kaen University, Khon Kaen, ThailandCholangiocarcinoma Research Institute, Khon Kaen University, Khon Kaen, ThailandDepartment of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, ThailandCholangiocarcinoma Screening and Care Program (CASCAP), Khon Kaen University, Khon Kaen, ThailandCholangiocarcinoma Research Institute, Khon Kaen University, Khon Kaen, ThailandDepartment of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, ThailandCholangiocarcinoma Screening and Care Program (CASCAP), Khon Kaen University, Khon Kaen, ThailandCholangiocarcinoma Research Institute, Khon Kaen University, Khon Kaen, ThailandDepartment of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, ThailandCholangiocarcinoma Screening and Care Program (CASCAP), Khon Kaen University, Khon Kaen, ThailandCholangiocarcinoma Research Institute, Khon Kaen University, Khon Kaen, ThailandDepartment of Biochemistry, Faculty of Medicine, Khon Kaen University, Khon Kaen, ThailandDepartment of Pathology, National University Hospital, Singapore, SingaporeCholangiocarcinoma Screening and Care Program (CASCAP), Khon Kaen University, Khon Kaen, ThailandCholangiocarcinoma Research Institute, Khon Kaen University, Khon Kaen, ThailandDepartment of Pathology, Faculty of Medicine, Khon Kaen University, Khon Kaen, ThailandAimThis study aims to improve the classification performance of the eighth American Joint Committee on Cancer (AJCC) staging system for perihilar cholangiocarcinoma (pCCA) by proposing the Khon Kaen University (KKU) staging system developed in cholangiocarcinoma-prevalent Northeast Thailand.MethodFour hundred eighty-eight patients with pCCA who underwent partial hepatectomy between 2002 and 2017 at the Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand, were included. Overall survival (OS) related to clinicopathological features was analyzed using the Kaplan–Meier method. Logrank test was performed in univariate analysis to compare OS data of clinicopathological features to determine risk factors for poor survival. Significant features were further analyzed by multivariate analysis (Cox regression) to identify prognostic factors which were then employed to modify the eighth AJCC staging system.ResultsMultivariate analysis showed that growth pattern (HR = 4.67–19.72, p < 0.001), moderately and poorly differentiated histological grades (HR = 2.31–4.99, p < 0.05 and 0.001, respectively), lymph node metastasis N1 and N2 (HR = 1.37 and 2.18, p < 0.05 and 0.01, respectively), and distant metastasis (HR = 2.11, p < 0.001) were independent factors when compared to their respective reference groups. There was a clear separation of patients with pCCA into KKU stage: I [OS = 116 months (mo.)], II (OS = 46 mo.), IIIA (OS = 24 mo.), IIIB (11 mo.), IVA (OS = 7 mo.), and IVB (OS = 6 mo.).ConclusionThe new staging system was based on the incorporation of growth patterns to modify the eighth AJCC staging system. The classification performance demonstrated that the KKU staging system was able to classify and distinctly separate patients with pCCA into those with good and poor outcomes. It was also able to improve the stratification performance and discriminative ability of different stages of pCCA classification better than the eighth AJCC staging system. Hence, the KKU staging system is proposed as an alternative model to augment the accuracy of survival prognostication and treatment performance for patients with pCCA.https://www.frontiersin.org/articles/10.3389/fmed.2022.893252/fullperihilar cholangiocarcinomaeighth AJCC/UICC stagingKKU staging systemclassificationgrowth pattern |
spellingShingle | Chaiwat Aphivatanasiri Chaiwat Aphivatanasiri Chaiwat Aphivatanasiri Prakasit Sa-Ngiamwibool Prakasit Sa-Ngiamwibool Prakasit Sa-Ngiamwibool Sakkarn Sangkhamanon Sakkarn Sangkhamanon Sakkarn Sangkhamanon Piyapharom Intarawichian Piyapharom Intarawichian Piyapharom Intarawichian Waritta Kunprom Waritta Kunprom Waritta Kunprom Malinee Thanee Malinee Thanee Malinee Thanee Piya Prajumwongs Piya Prajumwongs Piya Prajumwongs Narong Khuntikeo Narong Khuntikeo Narong Khuntikeo Attapol Titapun Attapol Titapun Attapol Titapun Apiwat Jareanrat Apiwat Jareanrat Apiwat Jareanrat Vasin Thanasukarn Vasin Thanasukarn Vasin Thanasukarn Tharatip Srisuk Tharatip Srisuk Tharatip Srisuk Vor Luvira Vor Luvira Vor Luvira Kulyada Eurboonyanun Kulyada Eurboonyanun Kulyada Eurboonyanun Julaluck Promsorn Julaluck Promsorn Julaluck Promsorn Watcharin Loilome Watcharin Loilome Watcharin Loilome Aileen Wee Supinda Koonmee Supinda Koonmee Supinda Koonmee Modification of the eighth AJCC/UICC staging system for perihilar cholangiocarcinoma: An alternative pathological staging system from cholangiocarcinoma-prevalent Northeast Thailand Frontiers in Medicine perihilar cholangiocarcinoma eighth AJCC/UICC staging KKU staging system classification growth pattern |
title | Modification of the eighth AJCC/UICC staging system for perihilar cholangiocarcinoma: An alternative pathological staging system from cholangiocarcinoma-prevalent Northeast Thailand |
title_full | Modification of the eighth AJCC/UICC staging system for perihilar cholangiocarcinoma: An alternative pathological staging system from cholangiocarcinoma-prevalent Northeast Thailand |
title_fullStr | Modification of the eighth AJCC/UICC staging system for perihilar cholangiocarcinoma: An alternative pathological staging system from cholangiocarcinoma-prevalent Northeast Thailand |
title_full_unstemmed | Modification of the eighth AJCC/UICC staging system for perihilar cholangiocarcinoma: An alternative pathological staging system from cholangiocarcinoma-prevalent Northeast Thailand |
title_short | Modification of the eighth AJCC/UICC staging system for perihilar cholangiocarcinoma: An alternative pathological staging system from cholangiocarcinoma-prevalent Northeast Thailand |
title_sort | modification of the eighth ajcc uicc staging system for perihilar cholangiocarcinoma an alternative pathological staging system from cholangiocarcinoma prevalent northeast thailand |
topic | perihilar cholangiocarcinoma eighth AJCC/UICC staging KKU staging system classification growth pattern |
url | https://www.frontiersin.org/articles/10.3389/fmed.2022.893252/full |
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