Validation of the 8th Edition American Joint Commission on Cancer (AJCC) Gallbladder Cancer Staging System: Prognostic Discrimination and Identification of Key Predictive Factors
Tested on 7,743 US patients, the 2017 gallbladder cancer staging system predicted survival no better than the 2010 one it replaced.
Overview
National Cancer Database analysis of 7,743 gallbladder carcinoma patients diagnosed 2005 to 2015 comparing AJCC seventh and eighth editions; 202 patients were reclassified. Overall survival concordance indices were 0.665 (eighth) and 0.663 (seventh). Within T1, T2 and T3, N2 carried higher mortality than N1. In stage IIIB or higher with known grade, higher stage, Charlson-Deyo score of 2 or more, higher grade and unknown nodal status raised the risk of death, while diagnosis after 2013, treatment at an academic centre, chemotherapy and radiotherapy lowered it; chemotherapy was associated with lower mortality in T3 to T4 and radiotherapy in T2 to T4. The authors call for prospective validation of the T2 subclassification.
- Concordance index for overall survival 0.665 (AJCC 8th) vs 0.663 (AJCC 7th).
- Radiotherapy associated with lower risk of death in T2 to T4 and chemotherapy in T3 to T4 disease (univariate, registry data).
Anatomy alone explains only about two thirds of the ranking of who lives longer; the 2026 staging review makes the same point and argues for molecular and nodal-burden modifiers alongside TNM.
- Registry data with missing grade and nodal information.
- Treatment associations are confounded by selection.
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