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Poster Display session 2

1025 - Liver metastases (LM) from intrahepatic cholangiocarcinoma (iCCA): Outcomes from the European Network for the Study of Cholangiocarcinoma (ENS-CCA) registry and implications on current American Joint Committee on Cancer (AJCC) staging.


29 Sep 2019


Poster Display session 2


Tumour Site

Hepatobiliary Cancers


Angela Lamarca


Annals of Oncology (2019) 30 (suppl_5): v253-v324. 10.1093/annonc/mdz247


A. Lamarca1, A. Santos2, K. Utpatel3, A. La Casta4, S. Stock3, A. Forner5, J. Adeva Alfonso6, T. Folseraas7, L. Fabris8, R. Macias9, M. Krawczyk10, M. Krawczyk11, V. Cardinale12, C. Braconi13, D. Alvaro12, M. Evert3, J. Bañales2, J.W. Valle1

Author affiliations

  • 1 Medical Oncology / Institute Of Cancer Sciences, The Christie NHS Foundation Trust / University of Manchester, M20 4BX - Manchester/GB
  • 2 Biology, Biodonostia, . - San Sebastian/ES
  • 3 Institute Of Pathology, University of Regensburg, . - Regensburg/DE
  • 4 Medical Oncology, University Hospital Donostia, . - San Sebastian/ES
  • 5 Liver Unit, Hospital Clínic Barcelona, . - Barcelona/ES
  • 6 Medical Oncology, University Hospital 12 De Octubre, 28041 - Madrid/ES
  • 7 Oslo University Hospital, Oslo University Hospital, Oslo/NO
  • 8 Molecular Medicine, University of Padua, . - Padua/IT
  • 9 Biology, University of Salamanca, . - Salamanca/ES
  • 10 Biology, Universitätsklinikum des Saarlandes, . - Homburg/DE
  • 11 Surgery, Medical University of Warsaw, . - Warsaw/PL
  • 12 Gastroenterology, Sapienza University of Rome, . - Rome/IT
  • 13 Medical Oncology, The Royal Marsden NHS Trust, . - London/GB


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Abstract 1025


The AJCC classifies LM of iCCA as early stage: T2b [stage II/IVa (AJCCv.7) and stage II/III (AJCCv.8) if N0/N1, respectively]; in contrast, LM are perceived by clinicians to be of poorer prognosis than other early stages.


Eligible patients (pts): iCCA from the ENS-CCA registry with survival / staging (AJCCv.7) data. Patients were classified: Group (g) A: stages I-III (excluding T2bN0); gB: stage IVa (excluding T2bN1M0); gC: LM (T2bN0/1); gD: stage IVb (M1 extra-hepatic disease). Primary end-point: overall survival (OS) (time from first diagnosis to death/last visit). Survival analysis was performed in a training set (TS) and findings validated in a validation set (VS); Kaplan Meier and Cox Regression. Sensitivity analysis (SA) was performed limiting gC to N0.


Of 1,820 pts (810 iCCA), 574 were eligible (141 TS; 433 VS). Following the new classification, 114 stage I-IVa pts (28.9%) were re-classified into the gC (75 N0; 39 N1): gA (192 pts; 33.5%), gB (89; 15.5), gC (114;19.8), gD (179; 31.2). In the TS, multivariate Cox Regression was adjusted for obesity (p 0.026) and performance status (p < 0.001); pts in gA (HR 0.39 (95%CI 0.18-0.85); p 0.017) had a lower risk of death (vs gC); gB and gD showed a trend towards better and shorter survival (vs gC), respectively, but differences did not reach statistical significance (p 0.109 and 0.737, respectively). Findings were validated in the VS: gA (vs gC) HR 0.34 (95%CI 0.24-0.49); p < 0.001. SA (whole series) confirmed independence from N1 status [gA (vs gC) HR 0.39 (95%CI 0.28-0.57); p < 0.001)]. Table shows outcome data for all stages (whole series).Table:


Whole series (n = 574)Freq (%)OS (months) median (95%CI)Multivariate Cox Regression HR (95% CI); p
Group A (AJCC v.7 stage I)19.741.8 (32.5-52.2)0.28 (0.19-0.40); < 0.001
Group A (AJCC v.7 stage II; excluding T2bN0)5.631.3 (18.5-41.4)0.48 (0.28-0.82); 0.007
Group A (AJCC v.7 stage III)8.223.5 (14.1-27.3)0.45 (0.29-0.69); < 0.001
Group B (AJCC v.7 stage IVa; excluding T2bN1)15.514.9 (11.6-21.7)0.77 (0.55-1.07); 0.118
Group C (LM; AJCC v.7 T2bN0/N1)19.910.9 (7.5-15.9)1 (Ref); n/a
Group D (AJCC v.7 stage IVb)31.18.4 (5.9-10.3)1.17 (0.89-1.54); 0.247


LM from iCCA have a worse outcome than other early stages (I-III). Unfortunately, the latest version of AJCC (AJCC v.8) does not take this into consideration; further changes in the AJCC classification are warranted.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

European Network for the Study of Cholangiocarcinoma (ENS-CCA).


ENS-CCA received funding from EASL Registry Award 2016 and Support from the Spanish Association of Gastroenterology (AEG), for the development of this registry; Dr Angela Lamarca received funding from Conquer Cancer Foundation of the American Society of Clinical Oncology (YIA 2017) and The Christie Charity.


A. Lamarca: Speaker Bureau / Expert testimony: Merck; Speaker Bureau / Expert testimony, Research grant / Funding (self), Travel / Accommodation / Expenses: Ipsen; Speaker Bureau / Expert testimony, Travel / Accommodation / Expenses: Pfizer; Travel / Accommodation / Expenses: Novartis; Travel / Accommodation / Expenses: Abott Nutrition; Travel / Accommodation / Expenses: Celgene; Travel / Accommodation / Expenses: AAA; Travel / Accommodation / Expenses: Sirtex Medical; Travel / Accommodation / Expenses: Bayer; Travel / Accommodation / Expenses: Delcath; Travel / Accommodation / Expenses: Mylan; Advisory / Consultancy: Eisai; Advisory / Consultancy: Nutricia. A. La Casta: Travel / Accommodation / Expenses: Celgene; Travel / Accommodation / Expenses: Ipsen; Travel / Accommodation / Expenses: Roche. A. Forner: Advisory / Consultancy: Guerbet; Speaker Bureau / Expert testimony, Travel / Accommodation / Expenses: Bayer; Speaker Bureau / Expert testimony: BTG. V. Cardinale: Licensing / Royalties: VESTA Therapeutics. D. Alvaro: Research grant / Funding (self), Licensing / Royalties: VESTA Therapeutics; Research grant / Funding (self): Intercept Pharmaceuticals. J.W. Valle: Honoraria (self), Advisory / Consultancy, Speaker Bureau / Expert testimony: Ipsen; Advisory / Consultancy, Speaker Bureau / Expert testimony, Research grant / Funding (institution): Novartis; Advisory / Consultancy: AstraZeneca; Advisory / Consultancy: Merck; Advisory / Consultancy: Delcath Systems; Advisory / Consultancy: Agios; Advisory / Consultancy: Pfizer; Advisory / Consultancy: PCI Biotech; Advisory / Consultancy: Incyte; Advisory / Consultancy: Keocyt; Advisory / Consultancy: QED Therapeutics; Advisory / Consultancy: Pieris Pharmaceuticals; Advisory / Consultancy: Genoscience Pharma; Advisory / Consultancy: Mundipharma EDO GmbH; Speaker Bureau / Expert testimony, Travel / Accommodation / Expenses: Nucana; Speaker Bureau / Expert testimony: Imaging Equipment Limited; Travel / Accommodation / Expenses: Celgene. All other authors have declared no conflicts of interest.

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