Risk estimation for biliary tract cancer: Development and validation of a prognostic score

Abstract

Here, we identified prognostic factors and propose a prognostic score to estimate survival, which can be applied to all patients independent of tumour site and before initial treatment. Further validation in prospective trials is required.

Multilevel heterogeneity of biliary tract cancers may affect the modelling of prognosis

“…To this latter regard, iCCA is frequently seen in Western counties in cases of underlying cirrhosis or PSC, whereas pCCA is often seen in patients with underlying PSC. Indeed, the percentage of cirrhosis reported by Schweitzerl et al was 17% and 10% in iCCA and pCCA/dCCA, respectively, and the fraction of hepatitis (viral, autoimmune) was higher in iCCA (13%); PSC affected an average of 10% of CCA patients irrespectively to the location, as expected. In this prognostic model, the presence of cirrhosis or PSC does not seem to influence the prognosis.…”

“…Cholangiocarcinoma (CCA) multilevel heterogeneity may affect the modelling of prognosis, and, indeed, the possibility to define pre‐operative survival was limited until recently. Schweitzerl et al developed and validated a novel pre‐operative clinical prognostic model for patients treated for biliary tract cancers (BTCs) including intrahepatic CCA, extrahepatic CCA and gallbladder cancer (GC). The prognostic score distinguished three groups of patients with a median OS of 21.8, 8.6 and 2.6 months respectively.…”

“…The prognostic score developed by Schweitzerl et al is easy to determine and could influence the management of CCA. However, a key question is whether it would be applicable in all patients affected by CCA irrespective of the gross, histological and molecular subtyping, or the underlying liver/bile duct disease.…”

“…In an ideal scenario, the prognostic model proposed by Schweitzerl et al could be integrated with evaluations of the tumour extension, histology, key targetable molecular alterations, and the severity of the underlying liver disease, such as signs of liver decompensation or portal hypertension, to tailor the therapeutic approach.…”

Anti-EGFR Monoclonal Antibodies in Advanced Biliary Tract Cancer: A Systematic Review and Meta-analysis

“…In particular, the incidence of iCCA is expected to further increase in the near future (6)(7)(8)(9). Currently, radical surgery with microscopically negative resection margins is the only potentially curative therapy available, although most patients are diagnosed in late disease stages (locally advanced/ unresectable or metastatic) (10,11). Moreover, even after complete surgical resection, the recurrence rate is high and the 5-year overall survival (OS) rate remains discouraging (20-35% at 5 years) (12)(13)(14).…”