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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

Overall Kaplan-Meier survival stratified by Bismuth-Corlette classification for HCCA. The median survival times were 27, 31, 21, and 14 months for B-C I, II, III, and IV types, respectively.
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Fig2: Overall Kaplan-Meier survival stratified by Bismuth-Corlette classification for HCCA. The median survival times were 27, 31, 21, and 14 months for B-C I, II, III, and IV types, respectively.

Mentions: The survival curves of HCCA patients with different B-C classification, TNM stage, and J-B classification were shown in Figures 2, 3, and 4. The median survival time were 27, 31, 21, and 14 months for B-C I, II, III, IV types; 35, 21, 18, and 8 months for TNM I, II, III, IV stages; and 27, 21, and 9 months for J-B T1, T2, and T3 stages, respectively.Figure 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)

Overall Kaplan-Meier survival stratified by Bismuth-Corlette classification for HCCA. The median survival times were 27, 31, 21, and 14 months for B-C I, II, III, and IV types, respectively.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig2: Overall Kaplan-Meier survival stratified by Bismuth-Corlette classification for HCCA. The median survival times were 27, 31, 21, and 14 months for B-C I, II, III, and IV types, respectively.
Mentions: The survival curves of HCCA patients with different B-C classification, TNM stage, and J-B classification were shown in Figures 2, 3, and 4. The median survival time were 27, 31, 21, and 14 months for B-C I, II, III, IV types; 35, 21, 18, and 8 months for TNM I, II, III, IV stages; and 27, 21, and 9 months for J-B T1, T2, and T3 stages, respectively.Figure 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