ArticleThe American journal of gastroenterology2014
A new clinically based staging system for perihilar cholangiocarcinoma.
Article in The American journal of gastroenterology, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 63 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
63 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Role of adjuvant (chemo)radiotherapy for resected extrahepatic cholangiocarcinoma: a meta-analysis.Journal of Zhejiang University. Science. B · 2020Pooled it
- Endobiliary radiofrequency ablation in recurrence and unresectable Perihilar cholangiocarcinoma.BMC gastroenterology · 2025Trial
- Comparative efficacy of interventions for jaundice in hilar cholangiocarcinoma: A retrospective analysis using the Mayo staging system.Medicine · 2026Article
- Primary percutaneous stenting for palliative biliary drainage of patients with malignant hilar biliary obstruction: TESLA trial.JHEP reports : innovation in hepatology · 2025Article
- Tumor necrosis facilitates perihilar cholangiocarcinoma metastasis by ANGPTL6-augmented vessel permeability and tumor dissemination.JHEP reports : innovation in hepatology · 2025Article
- Endobiliary Radiofrequency Ablation for Hepato-Biliary Diseases: A Narrative Review.Diseases (Basel, Switzerland) · 2025Review
- Ultrasound-guided percutaneous biopsy for challenging perihilar focal liver lesions: diagnostic accuracy and safety assessment.Journal of ultrasound · 2025Article
- Article
- National guidelines for the diagnosis and treatment of hilar cholangiocarcinoma.World journal of gastroenterology · 2024Review
- Treatment of cholangiocarcinoma in patients with primary sclerosing cholangitis: a comprehensive review.eGastroenterology · 2024Review
- Clinical significance of small extracellular vesicles in cholangiocarcinoma.Frontiers in oncology · 2024Review
- Artificial intelligence CT radiomics to predict early recurrence of intrahepatic cholangiocarcinoma: a multicenter study.Hepatology international · 2023Article
- Survival Analysis of 1140 Patients with Biliary Cancer and Benefit from Concurrent Renin-Angiotensin Antagonists, Statins, or Aspirin with Systemic Therapy.The oncologist · 2023Article
- How Can Machine Perfusion Change the Paradigm of Liver Transplantation for Patients with Perihilar Cholangiocarcinoma?Journal of clinical medicine · 2023Review
- Percutaneous transhepatic biliary drainage for biliary obstruction in perihilar cholangiocarcinoma: a 10-year analysis of safety and outcomes using the CCI index.Langenbeck's archives of surgery · 2023Observational
- Development and validation of machine learning models for predicting prognosis and guiding individualized postoperative chemotherapy: A real-world study of distal cholangiocarcinoma.Frontiers in oncology · 2023Article
- Safety and feasibility of laparoscopic radical resection for bismuth types III and IV hilar cholangiocarcinoma: a single-center experience from China.Frontiers in oncology · 2023Article
- Prognostic influence for hilar cholangiocarcinoma and comparisons of prognostic values of Mayo staging and TNM staging systems.Medicine · 2022Article
- Exhaled volatile organic compounds for cholangiocarcinoma diagnosis.Liver research (Beijing, China) · 2022Article
- Review
3 more citing papers are in PubMed but not listed here.
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Authors and funding
10 authors.
Funding
Abstract
objectivesCurrent staging systems for perihilar cholangiocarcinoma (pCCA) are inadequate, as they are based on surgical pathology and therefore not relevant to unresectable patients. Clinical trials for potential targeted therapies for pCCA are hampered by the lack of an accurate, nonoperative staging system for predicting survival. We aimed at developing a clinical staging system for pCCA, which would be of prognostic relevance for all pCCA patients and help stratify patients for clinical trials.
methodsClinical information at the time of pCCA diagnosis of 413 patients seen at Mayo Clinic, Rochester, MN between 2002 and 2010 was retrospectively analyzed. A survival predictive model was developed using Cox proportional hazards analysis. The performance of the staging system was compared with the current AJCC/UICC (the American Joint Committee on Cancer/the Union for International Cancer Control) 7th tumor-node-metastasis (TNM) staging system.
resultsEastern Cooperative Oncology Group (ECOG) status, tumor size and number, vascular encasement, lymph node and peritoneal metastasis and CA 19-9 level were grouped into a four-tier staging system. The median survivals of stages I, II, III, and IV patients were 48.6, 21.8, 8.6, and 2.8 months, with hazard ratios (95% confidence interval) of 1.0 (reference), 1.7 (1.1-2.6), 3.1 (2.0-4.7), and 8.7 (5.2-14.5), respectively (P<0.0001). This staging system had greater concordance statistics (standard error) than the TNM staging system (0.725 (0.018) vs. 0.614 (0.017)), indicating better performance in predicting survival.
conclusionsThis staging system, based on nonoperative information at the time of pCCA diagnosis, has excellent discriminatory power to classify patients into four prognostic stages. It could be useful to clinicians and for the design of clinical trials.
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