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    Liver metastases of intrahepatic cholangiocarcinoma: implications for a potential new staging system

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    Authors
    Lamarca, Angela
    Santos-Laso, A.
    Utpatel, K.
    La Casta, A.
    Stock, S.
    Forner, A.
    Adeva, J.
    Folseraas, T.
    Fabris, L.
    Ir Macias, R.
    Krawczyk, M.
    Krawczyk, M.
    Cardinale, V.
    Braconi, C.
    Alvaro, D.
    Evert, M.
    Banales, J. M.
    Valle, Juan W
    Show allShow less
    Affiliation
    Medical Oncology / Institute of Cancer Sciences, The Christie NHS Foundation Trust / University of Manchester, Manchester, United Kingdom.
    Issue Date
    2020
    
    Metadata
    Show full item record
    Abstract
    Background: Intrahepatic cholangiocarcinoma (iCCA) with liver metastases (LM) are perceived to have a poor prognosis but the American Joint Committee on Cancer (AJCC) classifies them as early stage in the absence of lymph nodes or extrahepatic spread. Methods: Patients with iCCA from the European Network for the Study of Cholangiocarcinoma (ENS-CCA) and Surveillance, Epidemiology, and End Results (SEER) registries with survival/staging (AJCCv.7) data were eligible. Modified staging was used (mAJCCv.7): Group-A: stages-I-III (excluding T2bN0); Group-B: stage-IVa (excluding T2bN1M0); Group-C: LM (T2bN0/1) and Group-D: stage-IVb (extra-hepatic metastases). Survival analysis (Kaplan Meier and Cox Regression) was performed in an ENS-CCA training cohort (TC) and findings internally [ENS-CCA (iVC)] and externally [SEER] validated. The aim was to assess if LM (Group-C) had a shorter survival compared to other early stages (Group-A). A modified version of AJCCv.8 (mAJCCv.8) is proposed. Results: Total of 574 and 4,171 patients from the ENS-CCA and SEER registries were included. Following the new classification, 19.86% and 17.31% of patients from the ENS-CCA and SEER registries were reclassified into the Group-C, respectively. In the ENS-CCA TC, multivariable Cox Regression was adjusted for obesity (p-value 0.026) and performance status (p-value <0.001); patients in Group-C (HR 2.53 (95%CI 1.18-5.42); p-value 0.017) had a higher risk of death (vs Group-A). Findings were validated in the ENS-CCA iVC (HR 2.93 (95%CI 2.04-4.19); p-value <0.001) and in the SEER registry (HR of 1.88 (95%CI 1.68-2.09); p-value <0.001). Conclusions: iCCA LM have a worse outcome than other early stages. As AJCCv.8 does not take this into consideration, a modification of AJCC v.8 (mAJCCv.8) including "liver metastases: multiple liver lesions, with or without vascular invasion" as a novel "M1a stage" is suggested.
    Citation
    Lamarca A, Santos-Laso A, Utpatel K, La Casta A, Stock S, Forner A, et al. Liver metastases of intrahepatic cholangiocarcinoma: implications for a potential new staging system. Hepatology. 2020.
    Journal
    Hepatology
    URI
    http://hdl.handle.net/10541/623402
    DOI
    10.1002/hep.31598
    PubMed ID
    33073396
    Additional Links
    https://dx.doi.org/10.1002/hep.31598
    Type
    Article
    Language
    en
    ae974a485f413a2113503eed53cd6c53
    10.1002/hep.31598
    Scopus Count
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