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Evaluating the Clinical Applicability of the European Staging System for Perihilar Cholangiocarcinoma
Hishaam Ismael*1, Evelyne M. Loyer2, Harmeet Kaur2, Claudius Conrad1, Jean-Nicolas Vauthey1, Thomas Aloia1
1Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX; 2Radiology, University of Texas MD Anderson Cancer Center, Houston, TX
Introduction:
In 2011, a new European Staging System (ESS) for perihilar cholangiocarcinoma was proposed with the expressed purpose of comparing treatment and outcomes data between institutions. The goal of this study was to evaluate the feasibility of ESS data capture.
Methods:
Forty-seven consecutive patients who underwent surgical resection for perihilar cholangiocarcinoma between 1999 and 2013 were studied.
Results:
The mean patient age was 63.2 and 62% were male. Preoperative imaging included high-resolution CT in all patients, MRI in 34%, and PET in 11%. R0 resection was accomplished in 80% of patients. Four patients (8.5%) and 18 patients (38.3%), respectively, received neoadjuvant or adjuvant therapy. During a mean follow-up of 36 months, recurrence rate was 51.3% and 2- and 5-year survivals were 69.4% and 33.3%, respectively. Analysis of data capture found that (T)umor classification was undeterminable in 7/47 patients (14.9%). For two patients, the (F)orm designation had insufficient data. The extent of vascular involvement (PV/HA) was different compared to preoperative imaging in 9 patients (19.1%). The liver remnant (V)olume was calculated in only 18 patients (38.3%). The liver (D)isease variable did not account for 4 patients with inflammation/cirrhosis. In total, only 15 patients (31.9%) had all required elements to complete the ESS.
Conclusions:
Without templated radiology, surgery and pathology reports the ESS cannot be applied to current clinical/research practice. Although resection continues to provide significant survival benefit to patients with perihilar cholangiocarcinoma, lack of an accurate prognostic tool for resectability and outcomes continues to be a major impediment to progress in the field.
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