Abstract：
BACKGROUND: The adjuvant S-1 trial affirmed adjuvant chemotherapy for biliary tract cancer but excluded pT1N0 distal cholangiocarcinoma (DCC) according to the seventh edition of the American Joint Committee on Cancer (AJCC) classification. The introduction of tumor depth of invasion (DOI) for T-classification in the eighth edition complicates identifying DCC patients less likely to benefit from adjuvant chemotherapy.
METHODS: Our cohort consisted of 185 patients with DCC who underwent pancreaticoduodenectomy between 2002 and 2019. We compared clinicopathological factors and survival outcomes between pT1N0 patients in the seventh edition and those in the eighth edition. New DOI cutoffs for subdividing pT1N0 (8th edition) patients were evaluated to identify patients less likely to benefit from adjuvant chemotherapy.
RESULTS: Transitioning to the eighth edition increased in pT1N0 cases from eight to 46. The 5-year cumulative recurrence rates of them were 14.3% for the seventh edition and 28.3% for the eighth edition. We proposed a DOI cutoff of <2 mm, at which the 5-year cumulative recurrence rate was 11.5%.
CONCLUSIONS: The eighth AJCC classification revealed that a significant proportion of pT1N0 DCC patients were at risk for recurrence. A DOI cutoff of <2 mm may be considered to potentially improve patient selection for adjuvant chemotherapy.
METHODS: Our cohort consisted of 185 patients with DCC who underwent pancreaticoduodenectomy between 2002 and 2019. We compared clinicopathological factors and survival outcomes between pT1N0 patients in the seventh edition and those in the eighth edition. New DOI cutoffs for subdividing pT1N0 (8th edition) patients were evaluated to identify patients less likely to benefit from adjuvant chemotherapy.
RESULTS: Transitioning to the eighth edition increased in pT1N0 cases from eight to 46. The 5-year cumulative recurrence rates of them were 14.3% for the seventh edition and 28.3% for the eighth edition. We proposed a DOI cutoff of <2 mm, at which the 5-year cumulative recurrence rate was 11.5%.
CONCLUSIONS: The eighth AJCC classification revealed that a significant proportion of pT1N0 DCC patients were at risk for recurrence. A DOI cutoff of <2 mm may be considered to potentially improve patient selection for adjuvant chemotherapy.
摘要：
背景：根据第七版美国癌症联合委员会（AJCC）分类，辅助S-1试验确认了胆道癌的辅助化疗，但排除了pT1N0远端胆管癌（DCC）。在第八版中引入肿瘤浸润深度（DOI）进行T分类，使识别不太可能从辅助化疗中受益的DCC患者变得复杂。
方法：我们的队列包括2002年至2019年间接受胰十二指肠切除术的185例DCC患者。我们比较了第七版和第八版pT1N0患者的临床病理因素和生存结果。对细分pT1N0（第8版）患者的新DOI截止值进行了评估，以确定不太可能从辅助化疗中受益的患者。
结果：过渡到第8版，pT1N0病例从8例增加到46例。第七版和第八版的5年累积复发率分别为14.3％和28.3％。我们建议DOI截止值<2mm，其中5年累积复发率为11.5%.
结论：第8次AJCC分类显示相当比例的pT1N0DCC患者有复发风险。<2mm的DOI截止值可以被认为潜在地改善患者对辅助化疗的选择。
方法：我们的队列包括2002年至2019年间接受胰十二指肠切除术的185例DCC患者。我们比较了第七版和第八版pT1N0患者的临床病理因素和生存结果。对细分pT1N0（第8版）患者的新DOI截止值进行了评估，以确定不太可能从辅助化疗中受益的患者。
结果：过渡到第8版，pT1N0病例从8例增加到46例。第七版和第八版的5年累积复发率分别为14.3％和28.3％。我们建议DOI截止值<2mm，其中5年累积复发率为11.5%.
结论：第8次AJCC分类显示相当比例的pT1N0DCC患者有复发风险。<2mm的DOI截止值可以被认为潜在地改善患者对辅助化疗的选择。
