Tumor multifocality, extension, grade, lymph node involvement, and age (MEGNA), a prognostic scoring system, may not be enough to assess overall survival and disease-free survival in patients with cholangiocarcinoma (CCA), according to a retrospective study.

The findings showed that the MEGNA score (c‐index=0.60) was similar to the frequently used tumor burden score (TBS; c‐index=0.58) and the American Joint Committee on Cancer (AJCC) eighth edition staging system (c‐index=0.58).

Notably, “all three demonstrated modest predictive ability, signifying the need for improved prognostic tools for intrahepatic CCA,” the study team said.

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The results were recently published in the Journal of Surgical Oncology.

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Previous reports in the literature found a better performance of this score compared to older methods such as AJCC.

“Although MEGNA successfully stratified patients relative to overall survival, its predictive ability was modest and largely comparable to existing staging systems,” the authors wrote.

The study included 800 patients previously diagnosed with CCA who underwent liver resection to analyze potential predictors of survival. Their mean age was 58 years. Males comprised 58.4% of the cohort. The overall survival at 5 years was 40.5%, while the disease-free survival was considerably low at 27.9%.

The researchers calculated the MEGNA, TBS, and AJCC scores and found similar results in their prognostic ability, suggesting no added benefit of using either of them.

A MEGNA score of 0 was correlated with a 40.1% 5-year disease-free survival, while patients with a score of 3 or higher had a 4.4% disease-free survival.

Although MEGNA was not independently associated with overall survival, other markers and parameters were. Elevated levels of carbohydrate antigen 19-9 successfully predicted both overall and disease-free survival. Positive resection margins and major vascular invasion were also associated with overall survival, while microvascular invasion independently predicted lower disease-free survival.

The discrepancy between these results could be due to differing geographical, incidence, risk factors, disease stage, and genomic characteristics between the samples of previous and this publication. Designing systems with better accuracy to assess outcomes in patients with CCA remains a present need.


Shaikh C, Alaimo L, Moazzam Z, et al. Predicting overall and recurrence‐free survival in patients with intrahepatic cholangiocarcinoma using the MEGNA score: a multi‐institutional analysis. J Surg Oncol. Published online September 14, 2022. doi:10.1002/jso.27098