| Purpose To evaluate the prognostic value of AJCC version 7 staging system for intrahepatic cholangiocarcinoma,and the value of lymph node ratio(LNR)in the prognosis of intrahepatic cholangiocarcinoma.Materials and Methods Data of intrahepatic cholangiocarcinoma patients were extracted from the SEER Surveillance Surveillance and End Result Database,Using the anatomical position coding(C22.1 intrahepatic cholangiocarcinoma)in the International Classification of Diseases for Oncology,3rd Edition(ICD-O-3).The extracted variables included gender,age,ethnicity,tumor size,cell differentiation,number of lymph node metastases,number of lymph nodes examined,AJCC6 staging criteria and AJCC7 staging criteria.A retrospective analysis of patients with intrahepatic cholangiocarcinoma was performed.The Determination of lymph node staging points using the Youden index.Calculation of total survival rate of AJCC 6th and 7th editions by Kaplan–Meier method.Using the log-rank method to compare the difference in survival time between stages in the two editions.The Cox proportional hazard model was used to analyze the prognostic factors by univariate and multivariate factors,and to screen out the risk factors affecting prognosis.Results1.A total of 16,470 patients with intrahepatic cholangiocarcinoma were screened according to relevant exclusion criteria,and a total of 357 patients with intrahepatic cholangiocarcinoma met the screening requirements.The 1-year,2-year and 3-year overall survival rates were 56.6%,30.0% and 15.4%.2.In the total stage,the stage III of the AJCC 6th edition was subdivided into 3sub-stages of IIIa,IIIb and IIIc,respectively.The survival time of stage IIIa was significantly better than that of stage IIIb and stage IIIc(P<0.001,log-rank).However,there was no significant difference in survival time between IIIb and IIIc(P>0.05,log-rank).In the 7th edition of AJCC,stage IV was divided into two sub-phases a and b.The median survival time of stage IVa was significantly better than that of stage IVb,but the difference was not very significant(p>0.05 log-rank).3.In terms of T staging,T2 stage was divided into T2 a stage and T2 b stage in the 7th edition.The prognosis of patients in T2 a stage was better than that in T2 b stage,but the difference was not significant(P>0.05,log-rank).4.In terms of N staging,N0 and N1 mean survival time were significantly different in AJCC version 6(P< 0.01,log-rank),and N0 and N1 mean survival time were significantly different in AJCC version 7(P< 0.01,log-rank).5.In terms of M staging,there was a statistically significant difference in the mean survival time of M0 and M1 in the sixth edition of AJCC(P=0.04,log-rank).The mean survival time of M0 and M1 in AJCC 7th edition also had significant statistical significance.Difference(P<0.01,log-rank).6.Univariate analysis showed that age,gender,tumor stage,lymph node metastasis,and LNR were independent risk factors for prognosis.However,further Cox multivariate analysis showed that age,gender,tumor stage,and lymph node positive rate were independent risk factors for the prognosis of patients.Lymph node positive rate ≥ 0.2 was an independent risk factor for prognosis(LNR ≥ 0.2vs.LNR<0.2,HR: 2.3,95% CI: 1.4-3.8,P< 0.05).Conclusion1.In terms of prognosis evaluation of intrahepatic cholangiocarcinoma,it is reasonable for AJCC version 7 staging system to divide T2 into T2 a and T2b;In the 7th edition of AJCC,it is reasonable to divide stage IV into a and b.N staging and M staging were more consistent in terms of prognosis than in the 6th edition.2.Gender,age,tumor stage and lymph node positive rate are independent prognostic factors of intrahepatic cholangiocarcinoma.3.The positive rate of lymph nodes is superior to the state of lymph node metastasis in predicting the survival of patients with intrahepatic cholangiocarcinoma.The lymph node positive rate is more reliable and accurate in guiding the prognosis than the lymph node staging system,and provides a basis for a reasonable staging system. |
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