Proposal for a new T-stage classification system for distal cholangiocarcinoma: a 10-institution study from the U.S. Extrahepatic Biliary Malignancy Consortium

Lauren M. Postlewait, Cecilia G. Ethun, Nina Le, Timothy M. Pawlik, Stefan Buettner, George Poultsides, Thuy Tran, Kamran Idrees, Chelsea A. Isom, Ryan C. Fields, Bradley Krasnick, Sharon M. Weber, Ahmed Salem, Robert C G Martin, Charles Scoggins, Perry Shen, Harveshp D. Mogal, Carl Schmidt, Eliza Beal, Ioannis HatzarasGerardo Vitiello, Kenneth Cardona, Shishir K. Maithel

Research output: Contribution to journalArticle


Background Seventh AJCC distal cholangiocarcinoma T-stage classification inadequately separates patients by survival. This retrospective study aimed to define a novel T-stage system to better stratify patients after resection. Methods Curative-intent pancreaticoduodenectomies for distal cholangiocarcinoma (1/2000-5/2015) at 10 US institutions were included. Relationships between tumor characteristics and overall survival (OS) were assessed and incorporated into a novel T-stage classification. Results 176 patients (median follow-up: 24mo) were included. Current AJCC T-stage was not associated with OS (T1: 23mo, T2: 20mo, T3: 25mo, T4: 12mo; p = 0.355). Tumor size ≥3 cm and presence of lymphovascular invasion (LVI) were associated with decreased OS on univariate and multivariable analyses. Patients were stratified into 3 groups [T1: size <3 cm and (−)LVI (n = 69; 39.2%); T2: size ≥3 cm and (−)LVI or size <3 cm and (+)LVI (n = 82; 46.6%); and T3: size ≥3 cm and (+)LVI (n = 25; 14.2%)]. Each progressive proposed T-stage was associated with decreased median OS (T1: 35mo; T2: 20mo; T3: 8mo; p = 0.002). Conclusion Current AJCC distal cholangiocarcinoma T-stage does not adequately stratify patients by survival. This proposed T-stage classification, based on tumor size and LVI, better differentiates patient outcomes after resection and could be considered for incorporation into the next AJCC distal cholangiocarcinoma staging system.

Original languageEnglish (US)
Pages (from-to)793-799
Number of pages7
Issue number10
Publication statusPublished - Oct 1 2016


ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this