Subserosal Layer and/or Pancreatic Invasion Based on Anatomical Features as a Novel Prognostic Indicator in Patients with Distal Cholangiocarcinoma.

The American Joint Committee on Cancer (AJCC) 8th edition T-staging system for distal cholangiocarcinoma (DCC) proposes classification according to the depth of invasion (DOI); nevertheless, DOI measurement is complex and irreproducible. This study focused on the fibromuscular layer and evaluated whether the presence or absence of penetrating fibromuscular invasion of DCC contributes to recurrence and prognosis. In total, 55 patients pathologically diagnosed with DCC who underwent surgical resection from 2002 to 2022 were clinicopathologically examined. Subserosal layer and/or pancreatic (SS/Panc) invasion, defined as penetration of the fibromuscular layer and invasion of the subserosal layer or pancreas by the cancer, was assessed with other clinicopathological prognostic factors to investigate recurrence and prognostic factors. According to the AJCC 8th edition, there were 11 T1, 28 T2, and 16 T3 cases, with 44 (80%) cases of SS/Panc invasion. The DOI was not significantly different for both recurrence and prognostic factors. In the multivariate analysis, only SS/Panc was identified as an independent factor for prognosis (hazard ratio: 16.1; 95% confidence interval: 2.1-118.8, p = 0.006). In conclusion, while the determination of DOI in DCC does not accurately reflect recurrence and prognosis, the presence of SS/Panc invasion may contribute to the T-staging system.

Evaluation of different staging methods on radical resection rate and prognosis of patients with hilar cholangiocarcinoma / 中华肝胆外科杂志

Objective@#To compare the Bismuth-Corlette typing, modified T-staging and Mayo staging system in predicting the radical resection rates and prognosis of patients with hilar cholangiocarcinoma (HCC).@*Methods@#The clinical data of 138 patients with hilar cholangiocarcinoma treated in the First Bethune Hospital of Jilin University were retrospectively analyzed. Three different staging methods were used.@*Results@#With increase in the classification level of the Bismuth-Corlette classification, the radical resection rate did not significantly decrease (P>0.05). The radical resection rates of stage T1, T2 and T3 in the modified T-staging system were 60.0% (27/45), 36.0% (10/28) and 14.0% (9/65) respectively (all P<0.05). The radical resection rates of patients in the stages I, II, III, IV of the Mayo Staging System were 86.0% (12/14), 50.0% (14/28), 29.0% (19/66) and 3/0% (1/30) respectively (all P<0.05). The overall survival time were no significant differences between the different Bismuth-Corlette and the modified T-staging system patients (P>0.05). However, there were significant differences among the survival rates in the various tumor staging levels using the Mayo Staging System.@*Conclusions@#The modified T-staging system and the Mayo staging system were more accurate than the Bismuth-Corlette typing system in predicting radical resection rates in patients with hilar cholangiocarcinoma. The Mayo staging system was superior to the Bismuth-Corlette typing system and the modified T-staging system in predicting prognosis of patients with hilar cholangiocarcinoma.

A new T staging system for nasopharyngeal carcinoma based on magnetic resonance imaging and intensity-modulated radiotherapy / 中华放射肿瘤学杂志

Objective To establish a new T staging system for nasopharyngeal carcinoma ( NPC) based on magnetic resonances imaging ( MRI) and intensity?modulated radiotherapy ( IMRT) . Methods A retrospective analysis was performed on the clinical data of 608 patients who were newly diagnosed with non?metastatic NPC by MRI and treated with IMRT in our hospital from 2008 to 2010. All patients were staged according to the 7th edition of the UICC/AJCC staging system for NPC. The survival rates were calculated using the Kaplan?Meier method and analyzed using the log?rank test. The Cox regression model was used for multivariate analyses. To deal with the deficiency in the current UICC/AJCC staging system, a new T staging system for NPC was established and systematically evaluated. Results The 5?year follow?up rate was 94?5%. The 5?year overall survival (OS), disease?free survival, local relapse?free survival (LRFS), and distant metastasis?free survival rates were 81?5%, 80?1%, 86?0%, and 81?1%, respectively. The univariate and multivariate analyses showed that the anatomic structures of nasopharynx, parapharyngeal space, and skull base were influencing factors for the OS rate (P=0?000?0?045). New T staging criteria were proposed based on the risk differences and survival curves:stage T1:invasion of the nasopharynx, parapharyngeal space, oropharynx, nasal cavity, skull base, and internal pterygoid muscle;stage T2:invasion of the external pterygoid muscle, paranasal sinus, intracalvarium, infratemporal fossa, and cranial nerves. The proposed T staging system achieved a good separation in both OS and LRFS curves. Conclusions The proposed new T staging system gives an objective prognostic prediction in patients with NPC, which provides an exploratory attempt toward a new clinical staging system for NPC.