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

World Journal of Surgical Oncology

Guixing Jiang¹  Zhengrong Wu¹  Wenchao Chen¹  Liping Cao¹  Yifei Yang¹  Guoping Ding¹ 

[1] Department of Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China

关键词: Jarnagin-Blumgart classification;    Survival;    Stage;    Hilar cholangiocarcinoma;   

Others  :  1137167
DOI  :  10.1186/s12957-015-0526-5

 received in 2014-10-07, accepted in 2015-02-24,  发布年份 2015

【 摘 要 】

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.

【 授权许可】

   
2015 Ding et al.; licensee BioMed Central.

【 图 表 】

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