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The MEGNA Score and Preoperative Anemia are Major Prognostic Factors After Resection in the German Intrahepatic Cholangiocarcinoma Cohort

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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.

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Funding

No funding was received for this project.

Author information

Authors and Affiliations

  1. Department of General and Visceral Surgery, University Hospital Frankfurt, Goethe-University Frankfurt, Frankfurt/Main, Germany

    Andreas A. Schnitzbauer MD, FACS, FEBS, Sabine Hannes MD & Wolf O. Bechstein MD

  2. Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany

    Johannes Eberhard MD & Felix Rückert MD

  3. Department of General, Visceral and Transplantation Surgery, University Hospital of Mainz, Mainz, Germany

    Fabian Bartsch MD & Hauke Lang MD

  4. Department of Surgery, Regensburg University Medical Center, Regensburg, Germany

    Stefan M. Brunner MD & Hans J. Schlitt MD, FACS, FRCS, FRCAS, MHM

  5. Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany

    Güralp O. Ceyhan MD & Helmut Fries MD

  6. Department for Medicine I, University Hospital Frankfurt, Goethe-University Frankfurt, Frankfurt/Main, Germany

    Dirk Walter MD

  7. Department of General and Thoracic Surgery, University Hospital of Giessen, Giessen, Germany

    Andreas Hecker MD

  8. Department of General, Visceral and Thoracic Surgery, University Medical Centre, Hamburg-Eppendorf, Hamburg, Germany

    Jun Li MD

  9. Department of General and Abdominal Surgery, Faculty of Medicine, Asklepios Hospital Barmbek, Semmelweis University Campus, Hamburg, Germany

    Karl Oldhafer MD, FEBS & Gregor Stavrou MD, habil

  10. Department of Gastrointestinal, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany

    Nuh Rahbari MD & Jürgen Weitz MD

  11. Department of General, Visceral and Vascular Surgery, Jena University Hospital, Jena, Germany

    Falk Rauchfuss MD & Utz Settmacher MD

Authors
  1. Andreas A. Schnitzbauer MD, FACS, FEBS
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  2. Johannes Eberhard MD
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  3. Fabian Bartsch MD
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  4. Stefan M. Brunner MD
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  5. Güralp O. Ceyhan MD
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  6. Dirk Walter MD
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  7. Helmut Fries MD
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  8. Sabine Hannes MD
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  9. Andreas Hecker MD
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  10. Jun Li MD
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  11. Karl Oldhafer MD, FEBS
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  12. Nuh Rahbari MD
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  13. Falk Rauchfuss MD
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  14. Hans J. Schlitt MD, FACS, FRCS, FRCAS, MHM
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  15. Utz Settmacher MD
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  16. Gregor Stavrou MD, habil
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  17. Jürgen Weitz MD
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  18. Hauke Lang MD
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  19. Wolf O. Bechstein MD
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  20. Felix Rückert MD
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Corresponding author

Correspondence to Andreas A. Schnitzbauer MD, FACS, FEBS.

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Disclosures

Andreas A. Schnitzbauer, Johannes Eberhard, Fabian Bartsch, Stefan M. Brunner, Güralp O. Ceyhan, Dirk Walter, Helmut Fries, Sabine Hannes, Andreas Hecker, Jun Li, Karl Oldhafer, Nuh Rahbari, Falk Rauchfuss, Hans J. Schlitt, Utz Settmacher, Gregor Stavrou, Jürgen Weitz, Hauke Lang, Wolf O. Bechstein and Felix Rückert declare they have no conflict of interests.

Approval

The Institutional Review Board of the Medical Faculty Mannheim of the University of Heidelberg provided approval for this project in April 2016 (2016-816R-MA).

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Schnitzbauer, A.A., Eberhard, J., Bartsch, F. et al. The MEGNA Score and Preoperative Anemia are Major Prognostic Factors After Resection in the German Intrahepatic Cholangiocarcinoma Cohort. Ann Surg Oncol 27, 1147–1155 (2020). https://doi.org/10.1245/s10434-019-07968-7

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  • DOI: https://doi.org/10.1245/s10434-019-07968-7

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