title: Hilar cholangiocarcinoma: tumor depth as a predictor of outcome.
abstract: BACKGROUND
  The American Joint Committee on Cancer staging system for hilar cholangiocarcinoma may be inaccurate because the bile duct lacks discrete tissue boundaries.
  
  
  OBJECTIVE
  To examine the accuracy of the American Joint Committee on Cancer staging schemes and to determine the prognostic implications of tumor depth.
  
  
  METHODS
  From January 1, 1987, through December 31, 2009, there were 106 patients who underwent resection of hilar cholangiocarcinoma who had pathologic slides available for re-review.
  
  
  METHODS
  Tumor depth and overall survival.
  
  
  RESULTS
  Overall median survival was 19.9 months. The 6th and 7th editions of the T-classification criteria were unable to discriminate among T1, T2, and T3 lesions (P > .05 for all). Median survival was associated with the invasion depth of the tumor (≥5 mm vs <5 mm): 18 months vs 30 months (P = .01). On multivariate analysis, tumor depth remained predictive of disease-specific death (hazard ratio, 1.70; P = .03).
  
  
  CONCLUSIONS
  The American Joint Committee on Cancer T-classification criteria did not stratify patients with regard to prognosis. Depth of tumor invasion is a better predictor of long-term outcome.
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
authors.forename: Mechteld C
authors.initials: MC
authors.lastname: de Jong
authors.forename: Seung-Mo
authors.initials: SM
authors.lastname: Hong
authors.forename: Mathew M
authors.initials: MM
authors.lastname: Augustine
authors.forename: Michael G
authors.initials: MG
authors.lastname: Goggins
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Wolfgang
authors.forename: Kenzo
authors.initials: K
authors.lastname: Hirose
authors.forename: Richard D
authors.initials: RD
authors.lastname: Schulick
authors.forename: Michael A
authors.initials: MA
authors.lastname: Choti
authors.forename: Robert A
authors.initials: RA
authors.lastname: Anders
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Pawlik
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D018281:Cholangiocarcinoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy; D006500:Hepatic Duct, Common / Q000601:surgery; D006801:Humans; D018285:Klatskin Tumor / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult