Andreas A Schnitzbauer1, Johannes Eberhard2, Fabian Bartsch3, Stefan M Brunner4, Güralp O Ceyhan5, Dirk Walter6, Helmut Fries5, Sabine Hannes7, Andreas Hecker8, Jun Li9, Karl Oldhafer10, Nuh Rahbari11, Falk Rauchfuss12, Hans J Schlitt4, Utz Settmacher12, Gregor Stavrou10, Jürgen Weitz11, Hauke Lang3, Wolf O Bechstein7, Felix Rückert2. 1. Department of General and Visceral Surgery, University Hospital Frankfurt, Goethe-University Frankfurt, Frankfurt/Main, Germany. andreas.schnitzbauer@kgu.de. 2. Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany. 3. Department of General, Visceral and Transplantation Surgery, University Hospital of Mainz, Mainz, Germany. 4. Department of Surgery, Regensburg University Medical Center, Regensburg, Germany. 5. Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany. 6. Department for Medicine I, University Hospital Frankfurt, Goethe-University Frankfurt, Frankfurt/Main, Germany. 7. Department of General and Visceral Surgery, University Hospital Frankfurt, Goethe-University Frankfurt, Frankfurt/Main, Germany. 8. Department of General and Thoracic Surgery, University Hospital of Giessen, Giessen, Germany. 9. Department of General, Visceral and Thoracic Surgery, University Medical Centre, Hamburg-Eppendorf, Hamburg, Germany. 10. Department of General and Abdominal Surgery, Faculty of Medicine, Asklepios Hospital Barmbek, Semmelweis University Campus, Hamburg, Germany. 11. Department of Gastrointestinal, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany. 12. Department of General, Visceral and Vascular Surgery, Jena University Hospital, Jena, Germany.
Abstract
BACKGROUND: Surgical resection is associated with the best long-term results for intrahepatic cholangiocarcinoma (ICC); however, long-term outcomes are still poor. OBJECTIVE: The primary aim of this study was to validate the recently proposed MEGNA score and to identify additional prognostic factors influencing short- and long-term survival. PATIENTS AND METHODS: This was a retrospective analysis of a German multicenter cohort operated at 10 tertiary centers from 2004 to 2013. Patients were clustered using the MEGNA score and overall survival was analyzed. Cox regression analysis was used to identify prognostic factors for both overall and 90-day survival. RESULTS: A total of 488 patients undergoing liver resection for ICC fulfilled the inclusion criteria and underwent analysis. Median age was 67 years, 72.5% of patients underwent major hepatic resection, and the lymphadenectomy rate was 86.9%. Median overall survival was 32.2 months. The MEGNA score significantly discriminated the long-term overall survival: 0 (68%), I (48%), II (32%), and III (19%) [p <0.001]. In addition, anemia was an independent prognostic factor for overall survival (hazard ratio 1.78, 95% confidence interval 1.29-2.45; p <0.01). CONCLUSION: Hepatic resection provides the best long-term survival in all risk groups (19-65% overall survival). The MEGNA score is a good discriminator using histopathologic items and age for stratification. Correction of anemia should be attempted in every patient who responds to treatment. Perioperative liver failure remains a clinical challenge and contributes to a relevant number of perioperative deaths.
BACKGROUND: Surgical resection is associated with the best long-term results for intrahepatic cholangiocarcinoma (ICC); however, long-term outcomes are still poor. OBJECTIVE: The primary aim of this study was to validate the recently proposed MEGNA score and to identify additional prognostic factors influencing short- and long-term survival. PATIENTS AND METHODS: This was a retrospective analysis of a German multicenter cohort operated at 10 tertiary centers from 2004 to 2013. Patients were clustered using the MEGNA score and overall survival was analyzed. Cox regression analysis was used to identify prognostic factors for both overall and 90-day survival. RESULTS: A total of 488 patients undergoing liver resection for ICC fulfilled the inclusion criteria and underwent analysis. Median age was 67 years, 72.5% of patients underwent major hepatic resection, and the lymphadenectomy rate was 86.9%. Median overall survival was 32.2 months. The MEGNA score significantly discriminated the long-term overall survival: 0 (68%), I (48%), II (32%), and III (19%) [p <0.001]. In addition, anemia was an independent prognostic factor for overall survival (hazard ratio 1.78, 95% confidence interval 1.29-2.45; p <0.01). CONCLUSION: Hepatic resection provides the best long-term survival in all risk groups (19-65% overall survival). The MEGNA score is a good discriminator using histopathologic items and age for stratification. Correction of anemia should be attempted in every patient who responds to treatment. Perioperative liver failure remains a clinical challenge and contributes to a relevant number of perioperative deaths.
Authors: Felix Hahn; Lukas Müller; Aline Mähringer-Kunz; Sebastian Schotten; Christoph Düber; Jan B Hinrichs; Sabine K Maschke; Peter R Galle; Fabian Bartsch; Hauke Lang; Arndt Weinmann; Roman Kloeckner Journal: PLoS One Date: 2020-02-03 Impact factor: 3.240
Authors: Lukas Müller; Aline Mähringer-Kunz; Simon Johannes Gairing; Friedrich Foerster; Arndt Weinmann; Fabian Bartsch; Lisa-Katharina Heuft; Janine Baumgart; Christoph Düber; Felix Hahn; Roman Kloeckner Journal: J Clin Med Date: 2021-05-12 Impact factor: 4.241