title: Comparison of the prognostic accuracy of the sixth and seventh editions of the TNM classification for intrahepatic cholangiocarcinoma.
abstract: BACKGROUND
  The seventh TNM edition introduced a new, specific staging structure for intrahepatic cholangiocarcinoma (IHC).
  
  
  OBJECTIVE
  To compare the accuracy of the sixth and the new seventh edition to predict survival after hepatectomy for IHC.
  
  
  METHODS
  In all, 434 consecutive patients who underwent hepatectomy at 16 tertiary-care centres (1990-2008) were identified. End points were overall (OS) and recurrence-free survival (RFS) for both T cohorts and stage strata.
  
  
  RESULTS
  After a median follow-up of 32.4 months, 3- and 5-year OS and RFS estimates were 47.1% and 32.9%, and 26.5% and 19.1%, respectively. Overall, both the editions were statistically significant discriminators of OS and RFS (P < 0.05). However, the survival curves of the new T2a and T2b cohorts appear superimposed. Conversely, the old T2 and T3 cohorts accurately stratify patients into distinct prognostic groups (P < 0.01). The seventh edition does not show monotonicity of gradients (the T4 category demonstrates significantly better OS and RFS compared with T2 patients). The seventh edition stage I and II are significantly different whereas the old stage I and II were not.
  
  
  CONCLUSIONS
  The new seventh edition of the AJCC/UICC Staging System proved to be adequate although further studies are need to confirm its superiority compared with the previous edition.
authors.affiliation: Department of Hepato-Biliary-Pancreatic and Digestive Surgery, Ospedale Mauriziano Umberto I, Torino, Italy. dribero@mauriziano.it
authors.forename: Dario
authors.initials: D
authors.lastname: Ribero
authors.forename: Gennaro
authors.initials: G
authors.lastname: Nuzzo
authors.forename: Marco
authors.initials: M
authors.lastname: Amisano
authors.forename: Mariano
authors.initials: M
authors.lastname: Tomatis
authors.forename: Alfredo
authors.initials: A
authors.lastname: Guglielmi
authors.forename: Stefano Maria
authors.initials: SM
authors.lastname: Giulini
authors.forename: Luca
authors.initials: L
authors.lastname: Aldrighetti
authors.forename: Fulvio
authors.initials: F
authors.lastname: Calise
authors.forename: Giorgio Enrico
authors.initials: GE
authors.lastname: Gerunda
authors.forename: Antonio Daniele
authors.initials: AD
authors.lastname: Pinna
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Capussotti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001650:Bile Duct Neoplasms / Q000145:classification* / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D001653:Bile Ducts, Intrahepatic / Q000473:pathology* / Q000601:surgery; D018281:Cholangiocarcinoma / Q000145:classification* / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000145:classification / Q000401:mortality / Q000592:standards; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods / Q000401:mortality; D011379:Prognosis; D015203:Reproducibility of Results