Published online Nov 28, 2019. doi: 10.3748/wjg.v25.i44.6541
Peer-review started: August 16, 2019
First decision: October 14, 2019
Revised: October 24, 2019
Accepted: November 13, 2019
Article in press: November 13, 2019
Published online: November 28, 2019
According to the latest American Joint Committee on Cancer and Union for International Cancer Control manuals, cystic duct cancer (CC) is categorized as a type of gallbladder cancer (GC), which has the worst prognosis among all types of biliary cancers. We hypothesized that this categorization could be verified by using taxonomic methods.
To investigate the categorization of CC based on population-level data.
Cases of biliary cancers were identified from the Surveillance, Epidemiology, and End Results 18 registries database. Together with routinely used statistical methods, three taxonomic methods, including Fisher’s discriminant, binary logistics and artificial neuron network (ANN) models, were used to clarify the categorizing problem of CC.
The T staging system of perihilar cholangiocarcinoma [a type of extrahepatic cholangiocarcinoma (EC)] better discriminated CC prognosis than that of GC. After adjusting other covariates, the hazard ratio of CC tended to be closer to that of EC, although not reaching statistical significance. To differentiate EC from GC, three taxonomic models were built and all showed good accuracies. The ANN model had an area under the receiver operating characteristic curve of 0.902. Using the three models, the majority (75.0%-77.8%) of CC cases were categorized as EC.
Our study suggested that CC should be categorized as a type of EC, not GC. Aggressive surgical attitude might be considered in CC cases, to see whether long-term prognosis could be immensely improved like the situation in EC.
Core tip: In the latest American Joint Committee on Cancer and Union for International Cancer Control manuals, cystic duct cancer (CC) is categorized as a type of gallbladder cancer, yet not verified by direct epidemiological evidence in previous studies. Our study used taxonomic methods to analyze population-based big data, including Fisher’s discriminant, binary logistics and artificial neuron network models. By using these three models, our study proved that CC is better to be deemed and treated as a kind of extrahepatic cholangiocarcinoma.