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Intrahepatic cholangiocarcinoma (iCCA) hidden amongst the unknown: A retrospective analysis of cancer of unknown primary (CUP) cases from a tertiary cancer centre
Conway, Alicia-Marie Morris, G Smith, S Manoharan, Prakash Mitchell, Claire L Backen, Alison C Oliveira, Pedro Lamarca, Angela McNamara, Mairead G
Conway, Alicia-Marie
Morris, G
Smith, S
Manoharan, Prakash
Mitchell, Claire L
Backen, Alison C
Oliveira, Pedro
Lamarca, Angela
McNamara, Mairead G
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Abstract
Background: Many patients (pts) with CUP present with presumed metastatic disease
to the liver. Due to lack of definitive histological markers, iCCA may be an overlooked
diagnosis. With the emergence of efficacious molecularly targeted therapies in iCCA,
this study assessed the potential frequency of iCCA (previously not identified) within a
CUP cohort.
Methods: A single-centre retrospective study of sequential pts referred to a regional
CUP multi-disciplinary team (MDT) (Jan 2017 - Apr 2020) was performed. Demographic data, histopathology, MDT history, treatment/survival outcomes were
collected. For pts presenting with liver involvement, baseline diagnostic imaging was
reviewed independently by a hepatobiliary radiologist and/or oncologist. Pts with
radiological features of iCCA (dominant liver lesion, capsular retraction) were
identified. For a subset of pts molecular characterisation of tumour tissue was
performed.
Results: Of 233 pts referred to the CUP MDT, 74 pts had malignancy involving the
liver. For 13 of these pts, a primary tumour diagnosis (different primaries) was subsequently established. Of the remaining liver-involved CUP cohort (n�61), 56 pts had
evaluable radiology reviewed and 25 (43%) had radiological features consistent with
iCCA. These 25 pts were predominantly female (n�19; 77%) with a median age of 65
years (range 31-79). 64% had an ECOG PS ?2 and 50% received first line platinum-based chemotherapy. Molecular alterations (IDH mutations/FGFR fusions) supporting
an iCCA diagnosis were detected in a subset of pts where testing was performed.
Median overall survival (OS) of the potential iCCA group (n�25) and remaining liver involved CUP group (not iCCA) were similar (OS 3.8 vs 3.9 months, logrank p-value �
0.805); comparatively, patients with subsequent primary diagnosis (and liver involvement, n�13) had significantly better OS (10.2 months, logrank p-value �
0.0227).
Conclusions: In this study 41% of patients referred with liver-involved CUP, matched
the radiological criteria for an iCCA diagnosis, highlighting the importance of identifying these pts within CUP cohorts, ensuring correct diagnosis, molecular characterisation and treatment.
Annals of Oncology abstracts
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Date
2021
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Citation
Conway A-M, Morris G, Smith S, Manoharan P, Mitchell CL, Backen A, et al. 58P Intrahepatic cholangiocarcinoma (iCCA) hidden amongst the unknown: A retrospective analysis of cancer of unknown primary (CUP) cases from a tertiary cancer centre. Vol. 32, Annals of Oncology. Elsevier BV; 2021. p. S380�1.