Liver Metastases of Intrahepatic Cholangiocarcinoma: Implications for an Updated Staging System

Autor: Jorge Adeva, Alvaro Santos-Laso, Vincenzo Cardinale, Marcin Krawczyk, Simone Stock, Alejandro Forner, Rocio I.R. Macias, Marek Krawczyk, Juan W. Valle, Adelaida La Casta, Domenico Alvaro, Chiara Braconi, Luca Fabris, Matthias Evert, Angela Lamarca, Trine Folseraas, Jesus M. Banales, Kirsten Utpatel
Přispěvatelé: European Commission
Rok vydání: 2021
Předmět:
Zdroj: Hepatology (Baltimore, Md.)
Addi. Archivo Digital para la Docencia y la Investigación
instname
Addi: Archivo Digital para la Docencia y la Investigación
Universidad del País Vasco
ISSN: 1527-3350
0270-9139
DOI: 10.1002/hep.31598
Popis: [EN] 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. APP ROA CH AND RESULT S: 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. (Hepatology 2021;73:2311-2325). The authors of this article are members of the European Network for the Study of Cholangiocarcinoma (ENS-CCA) and participate in the initiative European H2020 COST Action EURO-CHOLANGIO- NET granted by the COST Association (CA18122). The ENS-CCA registry is supported by the European Association for the Study of the Liver (EASL: Registry Grant Awards 2016 and 2019), the Spanish Association of Gastroenterology (AEG: RedCap access) and Incyte® (grant 2020). This article/publication is based upon work from COST Action European Cholangiocarcinoma Network, supported by COST (European Cooperation in Science and Technology). COST (European Cooperation in Science and Technology: www.cost.eu) is a funding agency for research and innovation networks. Drs. Angela Lamarca, Juan Valle and Jesus M. Banales also received funding from The Christie Charity and the European Union’s Horizon 2020 Research and Innovation Programme [grant number 825510, ESCALON]. Some of the authors of this manuscript are members of the European Reference Network (ERN)-Liver (Liver Tumor Working Group) (European H2020 project).
Databáze: OpenAIRE
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