title: Development and Validation of a Prognostic Score for Intrahepatic Cholangiocarcinoma.
abstract: In patients with intrahepatic cholangiocarcinoma (ICC), the oncologic benefit of surgery and perioperative outcomes for large multifocal tumors or tumors with contiguous organ involvement remain to be defined.
  
  
  
  To develop and externally validate a simplified prognostic score for ICC and to determine perioperative outcomes for large multifocal ICCs or tumors with contiguous organ involvement.
  
  
  
  This study of a contemporary cohort merged data from the California Cancer Registry (January 1, 2004, through December 31, 2011) and the Office of Statewide Health Planning and Development inpatient database. Clinicopathologic variables were compared between tumors that were intrahepatic, small (<7 cm), and solitary (ISS) and those that had extrahepatic extension and were large (≥7 cm) and multifocal (ELM). External validation of the prognostic model was performed using an independent data set from the National Cancer Institute's Surveillance, Epidemiology, and End Results database from January 1, 2004, through December 31, 2013.
  
  
  
  Patient overall survival after hepatectomy.
  
  
  
  A total of 275 patients (123 men [44.7%] and 152 women [55.3%]; median [interquartile range] age, 65 [55-72] years) met the inclusion criteria. No significant differences in overall complication rate (ISS, 48 [34.5%]; ELM, 37 [27.2%]; P = .19) and mortality rate (ISS, 10 [7.2%]; ELM, 6 [4.4%]; P = .32) were found. A multivariate Cox proportional hazards model demonstrated that multifocality, extrahepatic extension, grade, node positivity, and age greater than 60 years are independently associated with worse overall survival. These variables were used to develop the MEGNA prognostic score. The prognostic separation/discrimination index was improved with the MEGNA prognostic score (0.21; 95% CI, 0.11-0.33) compared with the staging systems of the American Joint Committee on Cancer sixth (0.17; 95% CI, 0.09-0.29) and seventh (0.18; 95% CI, 0.08-0.30) editions.
  
  
  
  The MEGNA prognostic score allows more accurate and superior estimation of patient survival after hepatectomy compared with current staging systems.
authors.affiliation: Department of Surgery, City of Hope National Medical Center, Duarte, California.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Raoof
authors.affiliation: Department of Surgery, City of Hope National Medical Center, Duarte, California.
authors.forename: Sinziana
authors.initials: S
authors.lastname: Dumitra
authors.affiliation: Department of Surgery, City of Hope National Medical Center, Duarte, California.
authors.forename: Philip H G
authors.initials: PHG
authors.lastname: Ituarte
authors.affiliation: Department of Surgery, City of Hope National Medical Center, Duarte, California.
authors.forename: Laleh
authors.initials: L
authors.lastname: Melstrom
authors.affiliation: Department of Surgery, City of Hope National Medical Center, Duarte, California.
authors.forename: Susanne G
authors.initials: SG
authors.lastname: Warner
authors.affiliation: Department of Surgery, City of Hope National Medical Center, Duarte, California.
authors.forename: Yuman
authors.initials: Y
authors.lastname: Fong
authors.affiliation: Department of Surgery, City of Hope National Medical Center, Duarte, California.
authors.forename: Gagandeep
authors.initials: G
authors.lastname: Singh
mesh_terms: D000367:Age Factors; D000368:Aged; D001650:Bile Duct Neoplasms / Q000473:pathology* / Q000601:surgery; D001653:Bile Ducts, Intrahepatic; D018281:Cholangiocarcinoma / Q000556:secondary* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009378:Neoplasms, Multiple Primary / Q000473:pathology* / Q000601:surgery; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries; D015996:Survival Rate; D047368:Tumor Burden