Outcome of resectable distal cholangiocarcinoma in a single-centre Western patient cohort: comparison of the 7th and 8th edition of the UICC/AJCC TNM classification

Authors

  • Maia Blomhoff Holm Department of Pathology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway https://orcid.org/0000-0002-3680-0259
  • Sondre Busund Department of HPB Surgery, Rikshospitalet, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway https://orcid.org/0009-0002-8477-6406
  • Rahul Rihel Institute of Clinical Medicine, University of Oslo, Oslo, Norway
  • Mushegh A. Sahakyan The Intervention Center, Rikshospitalet, Oslo University Hospital, Oslo, Norway; Department of Surgery, Ringerike Hospital, Vestre Viken Hospital Trust, Ringerike, Norway; Department of Surgery N1, Yerevan State Medical University, Yerevan, Armenia https://orcid.org/0000-0002-4815-7694
  • Ivar Prydz Gladhaug Department of HPB Surgery, Rikshospitalet, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway https://orcid.org/0000-0003-1441-6288
  • Caroline S. Verbeke Department of Pathology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway https://orcid.org/0000-0002-1111-9715
  • Sheraz Yaqub Department of HPB Surgery, Rikshospitalet, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway https://orcid.org/0000-0002-5696-2319
  • Dyre Kleive Department of HPB Surgery, Rikshospitalet, Oslo University Hospital, Oslo, Norway https://orcid.org/0000-0002-7072-8422

DOI:

https://doi.org/10.2340/1651-226X.2026.44965

Keywords:

Distal cholangiocarcinoma, TNM classification, Depth of invasion, Prognostic stratification

Abstract

Background and purpose: Distal cholangiocarcinoma (CCA) is a rare malignancy with poor prognosis, even after surgical resection. Accurate staging is essential for guiding treatment and predicting outcomes. The 8th edition of the Union for International Cancer Control (UICC)/The American Joint Committee on Cancer (AJCC) TNM classification introduced depth of tumour invasion (DOI) as the criterion for T-staging (T1–T3) and a three-tiered lymph node (N) classification. This study evaluates patient stratification and prognostic accuracy of the 8th versus 7th edition in a single-centre Western cohort and discusses difficulties with measuring DOI.

Patient/material and methods: Patients undergoing pancreatoduodenectomy for distal CCA at Oslo University Hospital (2015–2021) were retrospectively analysed. Tumours were restaged according to the 7th and 8th TNM editions. Survival was assessed using Kaplan–Meier estimates and log-rank tests to compare prognostic accuracy.

Results: Seventy-one patients were included. Using the 7th edition, most cancers (94.4%, 67 patients) were categorised as T3. With the 8th edition, stage redistribution was notable: T2 included 45 patients (63.4%) and T3 included 22 (31.0%). Five-year survival was significantly better for T2 (31.8%) than T3 (10.5%) according to the 8th edition, demonstrating improved discrimination. The revised N classification provided better prognostic distinction, with median survival of 30 months for N1 (1–3 nodes) and 23 months for N2 (≥4 nodes).

Interpretation: The 8th edition provides more accurate prognostic stratification of distal CCA compared to the 7th edition but requires meticulous, standardised pathology assessment to ensure accurate prognosis and appropriate post-surgical management.

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2026-02-19

How to Cite

Holm, M. B., Busund, S., Rihel, R., Sahakyan, M. A., Gladhaug, I. P., Verbeke, C. S., … Kleive, D. (2026). Outcome of resectable distal cholangiocarcinoma in a single-centre Western patient cohort: comparison of the 7th and 8th edition of the UICC/AJCC TNM classification. Acta Oncologica, 65, 148–155. https://doi.org/10.2340/1651-226X.2026.44965

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Vol. 65 (2026): Acta Oncologica

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Copyright (c) 2026 Maia Blomhoff Holm, Sondre Busund, Rahul Rihel, Mushegh A. Sahakyan, Ivar Prydz Gladhaug, Caroline S. Verbeke, Sheraz Yaqub, Dyre Kleive

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