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Authors: Hahn, Felix
Müller, Lukas
Mähringer-Kunz, Aline
Schotten, Sebastian
Düber, Christoph
Hinrichs, Jan B.
Maschke, Sabine K.
Galle, Peter R.
Bartsch, Fabian
Lang, Hauke
Weinmann, Arndt
Kloeckner, Roman
Title: Risk prediction in intrahepatic cholangiocarcinoma : direct comparison of the MEGNA score and the 8th edition of the UICC/AJCC cancer staging system
Online publication date: 30-Jun-2020
Language: english
Abstract: Background: External validation of prognostic risk models is essential before they are implemented in clinical practice. This study evaluated the recently developed MEGNA score for survival prediction after resection of intrahepatic cholangiocarcinoma (ICC), with a focus on the direct comparison of its prognostic value to that of the current International Union Against Cancer (UICC)/American Joint Committee on Cancer (AJCC) Cancer staging system. Material and methods Between 1997 and 2018, 417 consecutive patients with ICC were referred to our tertiary care centre and were retrospectively identified out of a dedicated clinical database. Of this group, 203 patients underwent surgical resection and met the inclusion criteria. Multivariate analysis was performed to assess the predictors of the recently proposed MEGNA score regarding overall survival (OS). Concordance indices (C-indices) and integrated Brier scores (IBS) were calculated to assess the ability of both the MEGNA score and the current (8th) edition of the UICC/AJCC Cancer staging system to predict individual patient outcome. Results: Stratification according to the MEGNA score resulted in a median OS of 34.5 months, 26.1 months, 21.5 months, and 16.6 months for MEGNA scores 0, 1, 2, and ≥3, respectively (log rank p < 0.001). However, of the five factors that contribute to the MEGNA score, age > 60 years was not a predictor for poor OS in our cohort. The C-index for the MEGNA score was 0.58, the IBS was 0.193. The 8th edition of the UICC/AJCC system performed slightly better, with a C-index of 0.61 and an IBS of 0.186. Conclusion: The ability of the MEGNA score to predict individual patient outcome was only moderate in this external validation. Its prognostic value did not reach that of the more widely known and used UICC/AJCC system. However, neither scoring system performed well enough to support clear-cut clinical decisions.
DDC: 610 Medizin
610 Medical sciences
Institution: Johannes Gutenberg-Universität Mainz
Department: FB 04 Medizin
Place: Mainz
Version: Published version
Publication type: Zeitschriftenaufsatz
License: CC BY
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Journal: PLOS ONE
Pages or article number: e0228501
Publisher: PLOS
Publisher place: San Francisco, California, US
Issue date: 2020
ISSN: 1932-6203
Publisher URL:
Publisher DOI: 10.1371/journal.pone.0228501
Appears in collections:JGU-Publikationen

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