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Comparative Study
. 2006 Jun;243(6):767-71; discussion 771-4.
doi: 10.1097/01.sla.0000219737.81943.4e.

Evidence-based gallbladder cancer staging: changing cancer staging by analysis of data from the National Cancer Database

Yuman Fong  1 , Lawrence Wagman, Mithat Gonen, James Crawford, William Reed, Richard Swanson, Charlie Pan, Jamie Ritchey, Andrew Stewart, Michael Choti
Affiliations
Comparative Study

Evidence-based gallbladder cancer staging: changing cancer staging by analysis of data from the National Cancer Database

Yuman Fong et al. Ann Surg. 2006 Jun.

Abstract

Background: A recent revision of the American Joint Committee on Cancer (AJCC) staging for gallbladder cancer (6th Edition) involved some major changes. Most notably, T2N0M0 tumors were moved from stage II to stage IB; T3N1M0 disease was moved from stage III to stage IIB; and T4NxM0 (x = any) tumors were moved from stage IVA to stage III.

Methods: In order to determine if these changes were justified by data, an analysis of the 10,705 cases of gallbladder cancer collected between 1989 and 1996 in the NCDB was performed. All patients had >5 year follow-up.

Results: The staging according to the 6th Edition provided no discrimination between stage III and IV. Five-year survivals for stage IIA, IIB, III, and IV (6th Edition) were 7%, 9%, 3%, 2% respectively. The data from the National Cancer Database (NCDB) were used to derive a proposed new staging system that builds upon Edition 5 and had improved discrimination of stage groups over previous editions.

Conclusions: Changes in staging systems should be justified by data. Multicenter databases, including the NCDB, represent important resources for verification of evidence-based staging systems.

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Figures

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FIGURE 1. Survival curves for all gallbladder cancer patients (n = 10,705) staged according to AJCC, 5th Edition or 6th Edition.
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FIGURE 2. Survival curves for all gallbladder cancer patients staged according to the proposed staging schema.
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FIGURE 3. Survival curves for gallbladder cancer patients subjected to potentially curative surgery (n = 7462) staged according to AJCC, 6th Edition or the proposed staging schema.
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