Am J Gastroenterol. 2023 Mar 20. doi: 10.14309/ajg.0000000000002258. Online ahead of print.
ABSTRACT
IntroductionIntrahepatic 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 iCCA patients.MethodsThe 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.ResultsEastern Cooperative Oncology Group (ECOG) status, tumor number, tumor size, metastasis, albumin, and CA 19-9 were incorporated into a 4-stage algorithm. Kaplan Meier estimates for 1-year survival were 87.1% (95%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 (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 to stage I (reference). Concordance indices showed the new staging system was superior to the TNM staging for predicting mortality in the derivation cohort, p-value <0.0001. In the validation cohort however, the difference between the 2 staging systems was not significant.DiscussionThe proposed independently-validated staging system uses non-histopathologic data to successfully stratify patients into four stages. This staging system has better prognostic accuracy compared to the TNM staging and can assist physicians and patients in treatment of iCCA.
PMID:36940423 | DOI:10.14309/ajg.0000000000002258
