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133. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

26.04. - 29.04.2016, Berlin

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Prognostic accuracy of the seventh edition of the TNM classification in comparison to the fifth and sixth edition for distal cholangiocarcinoma

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  • Georg Wiltberger - Uniklinik Leipzig, Klinik für Viszeral-, Transplantations-, Thorax- und Gefäßchirurgie, Leipzig, Deutschland
  • Felix Krenzien - Universitätsmedizin Berlin, Campus Virchow Klinikum, Klinik für Allgemein-, Viszeral-, und Transplantationschirurgie, Berlin, Deutschland
  • Georgi Atanasov - Universitätsmedizin Berlin, Campus Virchow Klinikum, Klinik für Allgemein-, Viszeral-, und Transplantationschirurgie, Berlin, Deutschland
  • Christian Benzing - Universitätsmedizin Berlin, Campus Virchow Klinikum, Klinik für Allgemein-, Viszeral-, und Transplantationschirurgie, Berlin, Deutschland
  • Hans-Michael Hau - Uniklinik Leipzig, Klinik für Viszeral-, Transplantations-, Thorax- und Gefäßchirurgie, Leipzig, Deutschland
  • Moritz Schmelzle - Universitätsmedizin Berlin, Campus Virchow Klinikum, Klinik für Allgemein-, Viszeral-, und Transplantationschirurgie, Berlin, Deutschland
  • Sven Jonas - 310Klinik Nürnberg, Klinik für Hepato-Pankreato-Biliäre Chirurgie, Nürnberg, Deutschland

Deutsche Gesellschaft für Chirurgie. 133. Kongress der Deutschen Gesellschaft für Chirurgie. Berlin, 26.-29.04.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. Doc16dgch214

doi: 10.3205/16dgch214, urn:nbn:de:0183-16dgch2145

Published: April 21, 2016

© 2016 Wiltberger et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Background: The TNM classification for distal cholangiocarcinoma was first introduced by the 7th edition 2009. However, the prognostic accuracy in comparison to the 5th and 6th edition has not yet been evaluated and requires validation.

Materials and methods: A prospective histological database was analyzed of patients with distal bile duct cancer. Histological parameters as well as the stage of the distal cholangiocarcinoma was assessed according to the 5th, 6th, and 7th edition of the TNM classification. Statistical analysis was performed by applying Log rank test, cox regression model, uni- and multivariate analysis.

Results: Between 1994 and 2012, 516 patients underwent pancreatic head resection of whom 59 patients (11.4%) suffered from histologically confirmed distal cholangiocarcinoma. The median overall survival time was 22.2 months (13.1 - 31.4). Tumor recurrence occurred in 23 patients after a median disease free survival time of 14.1 months. The 7th edition showed a monotonicity of all gradients with a stepwise increase of mortality related to a stepwise increase of tumor stage (Log rank test; p<0.05) demonstrating best discrimination of all tested editions (AUC=0.82; 95% CI 0.70 − 0.95; p=0.012). a. The discrimination was low for 5th (AUC=0.67; 95% CI 0.42 − 0.91; p=0.18) and 6th edition (AUC=0.70; 95% CI 0.47 − 0.93; p=0.11), while Log rank test did not reach statistical significance. On multivariate analysis, lymph node involvement and positive were positive and independent predictors of inferior survival (p<0.05).

Conclusion: The 7th edition was favorable in terms of predicting outcome and generated a monotonicity of all grades. Strikingly, the 7th edition, but not the 5th and 6th edition was of prognostic significance to predict outcome.