An ABC approach for preoperative staging in perihilar cholangiocarcinoma An international multicenter cohort study
Britte H E A Ten Haaft1, Alessandro M Bonomi2, Bas Groot Koerkamp3
1Amsterdam UMC, University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands.
Background & Aims:
Curative-intent surgery in patients with perihilar cholangiocarcinoma (pCCA) is associated with substantial surgical risks and high early-recurrence rates. This study aimed to develop an ABC system for preoperative staging of patients with pCCA.
Methods:
This retrospective international multicenter cohort study included patients with resected pCCA across 27 participating centers from 9 countries (2006-2022). The prognostic performance of the ABC system for overall survival (OS) and recurrence was assessed using multivariable (cause-specific) Cox regression.
Results:
Among 1307 included patients (median age, 66 [IQR, 57 to 73] years), independent prognostic factors for OS were: tumor size ≥25 mm (adjusted hazard ratio [aHR], 1.32 [95% CI, 1.13 to 1.55]; P=0.0003), CA19-9 ≥500 U/mL (aHR, 1.49 [1.22 to 1.81]; P<0.0001), and WHO performance status ≥1 (aHR, 1.35 [1.12-1.63]; P=0.002). The ABC score for OS consisted of 1 point for each independent prognostic factor (0-3 points); the ABC score for recurrence did not include WHO PS ≥1 (0-2 points). Compared to the ABC-0 group, the highest ABC risk group had a 3.4 times higher 90-day mortality risk (21 vs 6%; P=0.005), a 3.3 times higher 6-month recurrence rate (18 vs 5%; P<0.0001), a 3.0 times shorter median OS (13 vs 39 months; P=0.0001), and a 3.6 times lower 5-year OS rate (11 vs 35%; P=0.018). The prognostic value of the ABC score for OS remained similar in a sensitivity analysis including only patients with a resection post-2015 (Pinteraction=0.90).
Conclusions:
Following the ABC system, we should be reluctant to offer resection to patients with an ABC score of 3 with a tumor size ≥25 mm, CA19-9 ≥500 U/mL, and a WHO PS ≥1.
