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, H.; Hannes, Sabine; Hecker, Andreas; Li, Jun; Oldhafer, Karl J.; Rahbari, Nuh N.; Rauchfuß, F.; Schlitt, Hans J.; Settmacher, Utz; Stavrou, Gregor A.; Weitz, Jürgen; Lang, Hauke; Bechstein, Wolf O.; Rückert, Felix

doi:10.1245/s10434-019-07968-7

Cited by 28 publications

(34 citation statements)

References 23 publications

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“…Although the importance of surgical resection to achieve long-term survival is undisputed, not all patients benefit from hepatic resections. Especially in cases of advanced disease, poor survival rates were reported in previous publications of larger mono- and multicentric studies as confirmed in our present work [ 10 , 14 , 20 ]. With respect to the simultaneously reported considerable postoperative mortality of up to 10%, preoperative risk stratification is imperatively indicated [ 21 ].…”

Section: Discussionsupporting

confidence: 91%

“…This may be a result of an association between higher RSI values and tumor multifocality, which was identified as dependent risk factor for postoperative survival. Unlike other prominent scores, such as the recently validated MEGNA score, the RSI does not require postoperative data (e.g., histopathological staging) and thus can be of value not only for post- but also for preoperative therapeutic decision-making [ 14 ]. Of note, further well-known risk assessment scores, such as the FIB-4, ALBI, or Heidelberg score, were not further evaluated in the current study due to a lack of consistent preoperative monitoring of all required variables [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

“…Preoperative leukocytosis was defined as a leukocyte concentration of more than 11,000 per μl [ 13 ]. Preoperative anemia was defined as hemoglobin concentrations lower than 11.5 g/dl in female patients and lower than 13.5 g/dl in male patients, as recently suggested [ 14 ].…”

Section: Methodsmentioning

confidence: 99%

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Preoperative leukocytosis and the resection severity index are independent risk factors for survival in patients with intrahepatic cholangiocarcinoma

Beetz

Weigle

Cammann

et al. 2020

Langenbecks Arch Surg

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Purpose The incidence of intrahepatic cholangiocarcinoma is increasing worldwide. Despite advances in surgical and non-surgical treatment, reported outcomes are still poor and surgical resection remains to be the only chance for long-term survival of affected patients. The identification and validation of prognostic factors and scores, such as the recently introduced resection severity index, for postoperative morbidity and mortality are essential to facilitate optimal therapeutic regimens. Methods This is a retrospective analysis of 269 patients undergoing resection of histologically confirmed intrahepatic cholangiocarcinoma between February 1996 and September 2018 at a tertiary referral center for hepatobiliary surgery. Regression analyses were performed to evaluate potential prognostic factors, including the resection severity index. Results Median postoperative follow-up time was 22.93 (0.10–234.39) months. Severe postoperative complications (≥ Clavien-Dindo grade III) were observed in 94 (34.9%) patients. The body mass index (p = 0.035), the resection severity index (ASAT in U/l divided by Quick in % multiplied by the extent of liver resection graded in points; p = 0.006), additional hilar bile duct resection (p = 0.005), and number of packed red blood cells transfused during operation (p = 0.036) were independent risk factors for the onset of severe postoperative complications. Median Kaplan-Meier survival after resection was 27.63 months. Preoperative leukocytosis (p = 0.003), the resection severity index (p = 0.005), multivisceral resection (p = 0.001), and T stage ≥ 3 (p = 0.013) were identified as independent risk factors for survival. Conclusion Preoperative leukocytosis and the resection severity index are useful variables for preoperative risk stratification since they were identified as significant predictors for postoperative morbidity and mortality, respectively.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

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Preoperative leukocytosis and the resection severity index are independent risk factors for survival in patients with intrahepatic cholangiocarcinoma

Beetz

Weigle

Cammann

et al. 2020

Langenbecks Arch Surg

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“…Very recently, Schnitzbauer et al performed a multicentre analysis of the MEGNA score and validated the score in their study. They described an overall survival at the end of the 5 year follow-up period of 68%, 48%, 32%, and 19%, respectively, for MEGNA groups 0, 1, 2, and 3 [12]. Thus, they presented higher survival rates than in our cohort (43%, 28%, 18%, and 4%).…”

Section: Discussionmentioning

confidence: 47%

“…Recently, Schnitzbauer et al performed a multicentre validation of the MEGNA score, and came to the conclusion that the risk groups as proposed by the MEGNA score result in a significant stratification regarding OS [12]. However, a direct comparison with the current UICC cancer staging system was not presented.…”

Section: Introductionmentioning

confidence: 99%

Risk prediction in intrahepatic cholangiocarcinoma: Direct comparison of the MEGNA score and the 8th edition of the UICC/AJCC Cancer staging system

et al. 2020

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Predicting overall and recurrence‐free survival in patients with intrahepatic cholangiocarcinoma using the MEGNA score: A multi‐institutional analysis

Shaikh

Alaimo

Moazzam

et al. 2022

Journal of Surgical Oncology

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Background and Objectives: MEGNA is a prognostic scoring system for intrahepatic cholangiocarcinoma (ICC) based on tumor multifocality, extension, grade, lymph node positivity, and age. We sought to assess its predictive ability for overall survival (OS) and recurrence-free survival (RFS).Methods: Patients who underwent curative-intent liver resection for ICC between 2000 and 2020 were identified using an international multi-institutional database. Multivariate Cox regression was utilized to identify prognostic factors.Results: Among 800 patients with a median age of 58 years (interquartile range[IQR]: 50-68), the majority of patients were male (n = 467, 58.4%). 5-year OS was 40.5%, while 5-year RFS was 27.9%. The prognostic ability of MEGNA score (c-index = 0.60) was similar to AJCC (c-index = 0.58) and TBS (c-index = 0.58).

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

Cited by 28 publications

References 23 publications

Preoperative leukocytosis and the resection severity index are independent risk factors for survival in patients with intrahepatic cholangiocarcinoma

Preoperative leukocytosis and the resection severity index are independent risk factors for survival in patients with intrahepatic cholangiocarcinoma

Risk prediction in intrahepatic cholangiocarcinoma: Direct comparison of the MEGNA score and the 8th edition of the UICC/AJCC Cancer staging system

Predicting overall and recurrence‐free survival in patients with intrahepatic cholangiocarcinoma using the MEGNA score: A multi‐institutional analysis

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