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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Main Authors: Chaiwat Aphivatanasiri, Prakasit Sa-Ngiamwibool, Sakkarn Sangkhamanon, Piyapharom Intarawichian, Waritta Kunprom, Malinee Thanee, Piya Prajumwongs, Narong Khuntikeo, Attapol Titapun, Apiwat Jareanrat, Vasin Thanasukarn, Tharatip Srisuk, Vor Luvira, Kulyada Eurboonyanun, Julaluck Promsorn, Watcharin Loilome, Aileen Wee, Supinda Koonmee
Format: Article
Language:English
Published: Frontiers Media S.A. 2022-09-01
Series:Frontiers in Medicine
Subjects:
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.
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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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