Abstract 1025
Background
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.
Methods
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.
Results
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:
731P
Whole series (n = 574) | Freq (%) | OS (months) median (95%CI) | Multivariate Cox Regression HR (95% CI); p |
---|---|---|---|
Group A (AJCC v.7 stage I) | 19.7 | 41.8 (32.5-52.2) | 0.28 (0.19-0.40); < 0.001 |
Group A (AJCC v.7 stage II; excluding T2bN0) | 5.6 | 31.3 (18.5-41.4) | 0.48 (0.28-0.82); 0.007 |
Group A (AJCC v.7 stage III) | 8.2 | 23.5 (14.1-27.3) | 0.45 (0.29-0.69); < 0.001 |
Group B (AJCC v.7 stage IVa; excluding T2bN1) | 15.5 | 14.9 (11.6-21.7) | 0.77 (0.55-1.07); 0.118 |
Group C (LM; AJCC v.7 T2bN0/N1) | 19.9 | 10.9 (7.5-15.9) | 1 (Ref); n/a |
Group D (AJCC v.7 stage IVb) | 31.1 | 8.4 (5.9-10.3) | 1.17 (0.89-1.54); 0.247 |
Conclusions
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).
Funding
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.
Disclosure
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.
Resources from the same session
5629 - Outcome of triple negative inflammatory breast cancers (TNIBC) treated with dose dense neoadjuvant epirubicin cyclophosphmide, prognostic impact of pre and post neoadjuvant chemotherapy (NAC) tumor infiltrating lymphocytes (TIL) and post NAC lymphovascular invasion
Presenter: Luca Campedel
Session: Poster Display session 2
Resources:
Abstract
5792 - A novel PET parameter for cancer stem cell metabolism: early prediction of chemosensitivity to neoadjuvant chemotherapy in locally advanced breast cancer
Presenter: Chanwoo Kim
Session: Poster Display session 2
Resources:
Abstract
3728 - Using nodal ratio to predict recurrence in patients with 4 or more positive lymph nodes early stage breast cancer
Presenter: Besma Graja
Session: Poster Display session 2
Resources:
Abstract
3395 - Re-sentinel node biopsy for local recurrence after breast-conserving surgery
Presenter: Yuka Matsubara
Session: Poster Display session 2
Resources:
Abstract
4302 - Assessment of prognostic and therapeutic factors in men with breast cancer
Presenter: Daniel Herrero Rivera
Session: Poster Display session 2
Resources:
Abstract
4263 - Genomic Profiling of Chinese Breast Cancer Patients
Presenter: Zhonghua Tao
Session: Poster Display session 2
Resources:
Abstract
2406 - Genome copy number alteration burden represents predictor of response in long-term, never relapse exceptional responders of trastuzumab-treated HER2+ metastatic breast cancer
Presenter: Naomi Walsh
Session: Poster Display session 2
Resources:
Abstract
2575 - Next-generation DNA Sequencing (NGS) Results for Tumors From Phase 2 ABRAZO Study of Talazoparib After Platinum or Cytotoxic Non-Platinum Regimens in Patients (pts) With Advanced Breast Cancer (ABC) and Germline BRCA1/2 (gBRCA) Mutations
Presenter: Nicholas C. Turner
Session: Poster Display session 2
Resources:
Abstract
4499 - FGFR1 and CCND1 gene amplifications are associated with breast cancer resistance to aromatase inhibitors
Presenter: Evgeny Imyanitov
Session: Poster Display session 2
Resources:
Abstract
4110 - Clinicopathologic features of BRCA mutated breast cancer patients: Hacettepe Experience
Presenter: Sercan Aksoy
Session: Poster Display session 2
Resources:
Abstract