Perspective - Journal of Cancer Immunology & Therapy (2023) Volume , Issue
Staging and management process of cholangiocarcinoma
A holistic approach to prognostication, treatment classification and outcome comparison is best provided by staging systems. However, none of the CCA staging systems that are currently in use meets these requirements.
Intrahepatic CCA: The American Joint Committee on Cancer/Union for International CancerControl (AJCC/UICC), the Liver Cancer Study Group of Japan (LCSGJ) and the National Cancer Center of Japan (NCCN) staging methods are now the three main staging systems for iCCA. The staging mechanism of the AJCC/UICC is the only method that has demonstrated a link between stage and survival, although it is constrained by its need for histology to determine Tis and T4. The seventh edition AJCC/UICC staging method was outperformed by recently created prognostic nomograms and improvements to the existing LCSGJ staging system, however additional validation is needed.
Perihilar CCA: Although it was created to direct surgical therapy, the Bismuth-Corlette classification is not a staging system in the traditional sense. The AJCC/UICC and the Memorial Sloan Kettering Cancer Center (MSKCC) staging systems are the two most often used staging systems for pCCA. Since pCCA and dCCA are now staged independently for the first time in the most recent seventh edition of the AJCC/UICC staging system, further research is needed to confirm its predictive significance. The MSKCC staging system was unable to accurately separate patients with resectable cancer from those who weren't. There have been new staging mechanisms proposed, pending further evaluation. Very recently, a staging approach that was created exclusively from clinical data outperformed the TNM staging system and had outstanding predictive performance both with and without treatment.
Distal extrahepatic: The sole staging system for dCCA at the moment is the seventh edition of the AJCC/UICC. Its utility is constrained by the need for microscopic assessment of tumour infiltration depth and the lack of association between its T-stages and outcomes following resection.Author(s): Groot Jan*