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    Liver metastases of intrahepatic cholangiocarcinoma: implications for an updated staging system

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    Authors
    Lamarca, Angela
    Santos-Laso, Alvaro
    Utpatel, K.
    La Casta, Adelaida
    Stock, Simone
    Forner, Alejandro
    Adeva, Jorge
    Folseraas, Trine
    Fabris, Luca
    Macias, R. I. R.
    Krawczyk, Marcin
    Krawczyk, Marek
    Cardinale, Vincenzo
    Braconi, Chiara
    Alvaro, Domenico
    Evert, Matthias
    Banales, J. M.
    Valle, Juan W
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    Affiliation
    The Christie NHS Foundation Trust/University of Manchester, Manchester, United Kingdom
    Issue Date
    2021-06
    
    Metadata
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    Abstract
    Background and aims: Intrahepatic cholangiocarcinoma (iCCA) with liver metastases is 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. Approach and results: 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 (AJCC v.7) data were eligible. Modified staging was used (mAJCC v.7): group A: stages I-III (excluding T2bN0); group B: stage IVa (excluding T2bN1M0); group C: liver metastases (T2bN0/1); and group D: stage IVb (extrahepatic 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 whether liver metastases (group C) had a shorter survival compared to other early stages (group A) to propose a modified version of AJCC v.8 (mAJCC v.8). A 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 group C, respectively. In the ENS-CCA TC, multivariable Cox regression was adjusted for obesity (p = 0.026) and performance status (P < 0.001); patients in group C (HR, 2.53; 95% CI, 1.18-5.42; P = 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 < 0.001) and in the SEER registry (HR, 1.88; 95% CI, 1.68-2.09; P < 0.001). Conclusions: iCCA with liver metastases has a worse outcome than other early stages of iCCA. Given that AJCC v.8 does not take this into consideration, a modification of AJCC v.8 (mAJCC v.8), including "liver metastases: multiple liver lesions, with or without vascular invasion" as an "M1a stage," is suggested.
    Citation
    Angela Lamarca, Alvaro Santos-Laso, Kirsten Utpatel, Adelaida La Casta, Simone Stock, Alejandro Forner, et al. Liver metastases of intrahepatic cholangiocarcinoma: implications for an updated staging system. Hepatology. 2021 Jun;73(6):2311-2325.]
    Journal
    Hepatology
    URI
    http://hdl.handle.net/10541/624499
    DOI
    10.1002/hep.31598
    PubMed ID
    33073396
    Additional Links
    https://dx.doi.org/10.1002/hep.31598
    Type
    Article
    Language
    en
    ISSN
    0270-9139
    EISSN
    1527-3350
    ae974a485f413a2113503eed53cd6c53
    10.1002/hep.31598
    Scopus Count
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