CS-iCCA, A New Clinically Based Staging System for Intrahepatic Cholangiocarcinoma: Establishment and External Validation.

Autor:	Lozada ME; Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA.; Department of Surgery, University of Puerto Rico School of Medicine, San Juan, Puerto Rico, USA., Zhang N; Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA.; Integrated TCM & Western Medicine Department, the Fifth Medical Center, Chinese PLA General Hospital, Beijing, China., Jin W; Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA.; Department of General Surgery, Wuhan General Hospital of Guangzhou Military, Wuhan, China., Wongjarupong N; Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA.; Department of Medicine, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA., Yang JD; Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA.; Division of Digestive and Liver Diseases, Department of Internal Medicine, Comprehensive Transplant Center, and Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA., Voss MM; Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA., Prasai K; Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA., Amakye DO; Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA.; Department of Internal Medicine, Piedmont Athens Regional Medical Center, Athens, Georgia, USA., Harmsen WS; Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA., Chaudhary S; Departments of Surgery and Oncology, University of Calgary, Calgary, Alberta, Canada., Bathe OF; Departments of Surgery and Oncology, University of Calgary, Calgary, Alberta, Canada., Borad MJ; Division of Hematology and Medical Oncology, Mayo Clinic Hospital, Phoenix, Arizona, USA., Patel TC; Department of Transplantation and Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA., Gores GJ; Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA., Therneau TM; Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA., Roberts LR; Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA.
Jazyk:	angličtina
Zdroj:	The American journal of gastroenterology [Am J Gastroenterol] 2023 Dec 01; Vol. 118 (12), pp. 2173-2183. Date of Electronic Publication: 2023 Mar 20.
DOI:	10.14309/ajg.0000000000002258
Abstrakt:	Introduction: Intrahepatic cholangiocarcinoma (iCCA) is a primary liver malignancy with poor prognosis. Current prognostic methods are most accurate for patients with surgically resectable disease. However, a significant proportion of patients with iCCA are not surgical candidates. We aimed to develop a generalizable staging system based on clinical variables to determine prognosis of all patients with iCCA. Methods: The derivation cohort included 436 patients with iCCA seen between 2000 and 2011. For external validation, 249 patients with iCCA seen from 2000 to 2014 were enrolled. Survival analysis was performed to identify prognostic predictors. All-cause mortality was the primary end point. Results: Eastern Cooperative Oncology Group status, tumor number, tumor size, metastasis, albumin, and carbohydrate antigen 19-9 were incorporated into a 4-stage algorithm. Kaplan-Meier estimates for 1-year survival were 87.1% (95% confidence interval [CI] 76.1-99.7), 72.7% (95% CI 63.4-83.4), 48.0% (95% CI 41.2-56.0), and 16% (95% CI 11-23.5), respectively, for stages I, II, III, and IV. Univariate analysis yielded significant differences in risk of death for stages II (hazard ratio [HR] 1.71; 95% CI 1.0-2.8), III (HR 3.32; 95% CI 2.07-5.31), and IV (HR 7.44; 95% CI 4.61-12.01) compared with stage I (reference). Concordance indices showed the new staging system was superior to the TNM staging for predicting mortality in the derivation cohort, P < 0.0001. In the validation cohort, however, the difference between the 2 staging systems was not significant. Discussion: The proposed independently validated staging system uses nonhistopathologic data to successfully stratify patients into 4 stages. This staging system has better prognostic accuracy compared with the TNM staging and can assist physicians and patients in treatment of iCCA. (Copyright © 2023 by The American College of Gastroenterology.)
Databáze:	MEDLINE
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