Development and Validation of a Prognostic Score for Intrahepatic Cholangiocarcinoma

Abstract

IMPORTANCE In patients with intrahepatic cholangiocarcinoma (ICC), the oncologic benefit of surgery and perioperative outcomes for large multifocal tumors or tumors with contiguous organ involvement remain to be defined. OBJECTIVES To develop and externally validate a simplified prognostic score for ICC and to determine perioperative outcomes for large multifocal ICCs or tumors with contiguous organ involvement. DESIGN, SETTING, AND PARTICIPANTS This study of a contemporary cohort merged data from the California Cancer Registry (January 1, 2004, through December 31, 2011) and the Office of Statewide Health Planning and Development inpatient database. Clinicopathologic variables were compared between tumors that were intrahepatic, small (<7 cm), and solitary (ISS) and those that had extrahepatic extension and were large (≥7 cm) and multifocal (ELM). External validation of the prognostic model was performed using an independent data set from the National Cancer Institute’s Surveillance, Epidemiology, and End Results database from January 1, 2004, through December 31, 2013. MAIN OUTCOMES AND MEASURES Patient overall survival after hepatectomy. RESULTS A total of 275 patients (123 men [44.7%] and 152 women [55.3%]; median [interquartile range] age, 65 [55–72] years) met the inclusion criteria. No significant differences in overall complication rate (ISS, 48 [34.5%]; ELM, 37 [27.2%]; P = .19) and mortality rate (ISS, 10 [7.2%]; ELM, 6 [4.4%]; P = .32) were found. A multivariate Cox proportional hazards model demonstrated that multifocality, extrahepatic extension, grade, node positivity, and age greater than 60 years are independently associated with worse overall survival. These variables were used to develop the MEGNA prognostic score. The prognostic separation/discrimination index was improved with the MEGNA prognostic score (0.21; 95% CI, 0.11–0.33) compared with the staging systems of the American Joint Committee on Cancer sixth (0.17; 95% CI, 0.09–0.29) and seventh (0.18; 95% CI, 0.08–0.30) editions. CONCLUSIONS AND RELEVANCE The MEGNA prognostic score allows more accurate and superior estimation of patient survival after hepatectomy compared with current staging systems.

Risk prediction in intrahepatic cholangiocarcinoma: Direct comparison of the MEGNA score and the 8th edition of the UICC/AJCC Cancer staging system

“…Node positivity was slightly less compared with the original cohort (18% vs 20%). Age (median 63 y, IQR 55-71 y vs 65 y, IQR 55-72y), multifocality (unifocal 78% vs 81%), extrahepatic extension (9% vs 10%), and grading Prediction error Score (poorly differentiated 33% vs 30%) were comparable between the two cohorts [11]. Thus, the cohorts were quite similar regarding the MEGNA factors; given this level of similarity a better performance of the MEGNA score was expected a priori.…”

“…The suggested age cut-off of 60 years was not associated with an increased hazard ratio in our cohort, thus rendering one factor out of five entirely dispensable and adding one degree of uncertainty to the risk stratification. Whether age is an additional independent predictor of Risk prediction in ICC: Direct comparison of the MEGNA score and the 8th edition of the UICC staging system 4.5-11.0 cm vs median 5.5 cm, IQR 3.5-8.0 cm) [11]. Node positivity was slightly less compared with the original cohort (18% vs 20%).…”

“…In 2017, Raoof et al developed a novel scoring system to predict outcomes of patients with ICC after resection [11]. Their MEGNA score consists of five factors: age > 60 years, multifocality, extrahepatic tumour extension, tumour grading, and lymph node metastasis.…”

“…Extrahepatic tumour extension was defined as "any perforation of the visceral peritoneum, invasion of the hepatic artery or vena cava, and involvement of surrounding viscera". The authors themselves validated their score using an independent data set from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) registry, and came to the conclusion that MEGNA is superior in predicting patient survival after hepatectomy compared with current staging systems [11].…”

Role of the overexpression of TRAF4 in predictingthe prognosis of intrahepatic cholangiocarcinoma

“…Previous studies have indicated that ICC exhibits aggressive malignancy and has a higher malignancy than HCC (5,6). The prognosis of patients with ICC remains poor, with a 30% 5-year overall survival (OS) rate, according to previous studies (1,7,8). Therefore, more effective prognostic factors are required to improve the overall prognosis and to guide treatment approaches for patients with ICC.…”