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A modified Jarnagin-Blumgart classification better predicts survival for resectable hilar cholangiocarcinoma.

Ding G, Yang Y, Cao L, Chen W, Wu Z, Jiang G - World J Surg Oncol (2015)

Bottom Line: There was no significant difference in resectability within the groups B-C type and TNM stages.J-B classification was more useful than B-C classification, while its value for predicting survival did not exceed TNM staging system.The new staging system, based on J-B classification, provides a better method to stratify HCCA patients during the operation.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, China. dinguop@zju.edu.cn.

ABSTRACT

Background: Prediction of postoperative survival for hilar cholangiocarcinoma (HCCA) remains difficult although there have been a variety of clinical classification and staging systems. This study was designed to validate and compare some of the major HCCA staging systems in use today. In addition, we sought to build up a new staging system modified from Jarnagin-Blumgart (J-B) classification for HCCA, to predict survival better.

Methods: A total of 154 consecutive cases of HCCA including 95 surgical patients between 2005 and 2014 were enrolled in this study. The clinical and pathological data were recorded retrospectively and three commonly used classification methods: Bismuth-Corlette (B-C) classification, TNM staging, and J-B classification were performed to analyze the correlations with resectability and survival. Chi-square test, Kaplan-Meier analysis, and kappa statistics were used to compare and confirm the relationships between the variables and survival.

Results: For all 154 patients, the resection rate of J-B T1 was 68.6% (48/70), higher than that of J-B T2 (44.8%, P = 0.007). J-B T2 also showed a higher resectability than J-B T3 (19.2%, P = 0.025). There was no significant difference in resectability within the groups B-C type and TNM stages. We set up a new staging system based on J-B classification, tumor differentiation, distant metastasis (N2 or M1 of TNM stage), and resection integrality. The total survival predictive accuracy was 69.5% (kappa = 0.547), higher than that of TNM staging and J-B classification.

Conclusions: J-B classification was more useful than B-C classification, while its value for predicting survival did not exceed TNM staging system. The new staging system, based on J-B classification, provides a better method to stratify HCCA patients during the operation.

No MeSH data available.


Related in: MedlinePlus

Survival curve of 95 HCCA patients after surgical treatment. The median survival time for all the 95 HCCA patients was 21.5 months. The 1-, 3-, and 5-year survival rates were 72%, 26%, and 21%, respectively.
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Fig1: Survival curve of 95 HCCA patients after surgical treatment. The median survival time for all the 95 HCCA patients was 21.5 months. The 1-, 3-, and 5-year survival rates were 72%, 26%, and 21%, respectively.

Mentions: To compare values of the three staging methods for predicting survival of HCCA, we analyzed the survival of 95 surgical patients. The main clinical and pathologic variables correlated with survival are shown in Table 2. The median survival time of was 21.5 months. The 1-, 3-, and 5-year accumulative survival rates were 72%, 26%, and 21%, respectively (Figure 1). The survival time of 75 patients who died ranged from 3 to 47 months, among which 27 (36%) died in the first year after resection, 43 (57.3%) died between 1 to 3 years, and 5 (6.7%) died between 3 to 5 years. Chi-square test indicated that TNM stage, J-B classification, tumor differentiation, LN involvement, distant metastasis, and margin status were significantly correlated with survival, while gender, age, upper abdominal pain, jaundice, and B-C classification were not (Table 1).Table 2


A modified Jarnagin-Blumgart classification better predicts survival for resectable hilar cholangiocarcinoma.

Ding G, Yang Y, Cao L, Chen W, Wu Z, Jiang G - World J Surg Oncol (2015)

Survival curve of 95 HCCA patients after surgical treatment. The median survival time for all the 95 HCCA patients was 21.5 months. The 1-, 3-, and 5-year survival rates were 72%, 26%, and 21%, respectively.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4359437&req=5

Fig1: Survival curve of 95 HCCA patients after surgical treatment. The median survival time for all the 95 HCCA patients was 21.5 months. The 1-, 3-, and 5-year survival rates were 72%, 26%, and 21%, respectively.
Mentions: To compare values of the three staging methods for predicting survival of HCCA, we analyzed the survival of 95 surgical patients. The main clinical and pathologic variables correlated with survival are shown in Table 2. The median survival time of was 21.5 months. The 1-, 3-, and 5-year accumulative survival rates were 72%, 26%, and 21%, respectively (Figure 1). The survival time of 75 patients who died ranged from 3 to 47 months, among which 27 (36%) died in the first year after resection, 43 (57.3%) died between 1 to 3 years, and 5 (6.7%) died between 3 to 5 years. Chi-square test indicated that TNM stage, J-B classification, tumor differentiation, LN involvement, distant metastasis, and margin status were significantly correlated with survival, while gender, age, upper abdominal pain, jaundice, and B-C classification were not (Table 1).Table 2

Bottom Line: There was no significant difference in resectability within the groups B-C type and TNM stages.J-B classification was more useful than B-C classification, while its value for predicting survival did not exceed TNM staging system.The new staging system, based on J-B classification, provides a better method to stratify HCCA patients during the operation.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, China. dinguop@zju.edu.cn.

ABSTRACT

Background: Prediction of postoperative survival for hilar cholangiocarcinoma (HCCA) remains difficult although there have been a variety of clinical classification and staging systems. This study was designed to validate and compare some of the major HCCA staging systems in use today. In addition, we sought to build up a new staging system modified from Jarnagin-Blumgart (J-B) classification for HCCA, to predict survival better.

Methods: A total of 154 consecutive cases of HCCA including 95 surgical patients between 2005 and 2014 were enrolled in this study. The clinical and pathological data were recorded retrospectively and three commonly used classification methods: Bismuth-Corlette (B-C) classification, TNM staging, and J-B classification were performed to analyze the correlations with resectability and survival. Chi-square test, Kaplan-Meier analysis, and kappa statistics were used to compare and confirm the relationships between the variables and survival.

Results: For all 154 patients, the resection rate of J-B T1 was 68.6% (48/70), higher than that of J-B T2 (44.8%, P = 0.007). J-B T2 also showed a higher resectability than J-B T3 (19.2%, P = 0.025). There was no significant difference in resectability within the groups B-C type and TNM stages. We set up a new staging system based on J-B classification, tumor differentiation, distant metastasis (N2 or M1 of TNM stage), and resection integrality. The total survival predictive accuracy was 69.5% (kappa = 0.547), higher than that of TNM staging and J-B classification.

Conclusions: J-B classification was more useful than B-C classification, while its value for predicting survival did not exceed TNM staging system. The new staging system, based on J-B classification, provides a better method to stratify HCCA patients during the operation.

No MeSH data available.


Related in: MedlinePlus