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

Schnitzbauer, Andreas A; Eberhard, Johannes; Bartsch, Fabian; Brunner, Stefan M; Ceyhan, Güralp O; Walter, Dirk; Fries, Helmut; Hannes, Sabine; Hecker, Andreas; Li, Jun; Oldhafer, Karl; Rahbari, Nuh; Rauchfuss, Falk; Schlitt, Hans J; Settmacher, Utz; Stavrou, Gregor; Weitz, Jürgen; Lang, Hauke; Bechstein, Wolf O; Rückert, Felix

doi:10.1245/s10434-019-07968-7

2020

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Title:: The MEGNA Score and Preoperative Anemia are Major Prognostic Factors After Resection in the German Intrahepatic Cholangiocarcinoma Cohort.
Document type:: Journal Article
Author(s):: Schnitzbauer, Andreas A; Eberhard, Johannes; Bartsch, Fabian; Brunner, Stefan M; Ceyhan, Güralp O; Walter, Dirk; Fries, Helmut; Hannes, Sabine; Hecker, Andreas; Li, Jun; Oldhafer, Karl; Rahbari, Nuh; Rauchfuss, Falk; Schlitt, Hans J; Settmacher, Utz; Stavrou, Gregor; Weitz, Jürgen; Lang, Hauke; Bechstein, Wolf O; Rückert, Felix
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.
Journal title abbreviation:: Ann Surg Oncol
Year:: 2020
Journal volume:: 27
Journal issue:: 4
Pages contribution:: 1147-1155
Fulltext / DOI:: doi:10.1245/s10434-019-07968-7
Pubmed ID:: http://view.ncbi.nlm.nih.gov/pubmed/31646454
Print-ISSN:: 1068-9265
TUM Institution:: 525; Chirurgische Klinik und Poliklinik
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mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Departments Clinical Medicine Klinik und Poliklinik für Chirurgie (Prof. Friess)2020