A research team has developed and validated a preoperative magnetic resonance imaging (MRI)-based prognostic model to help clinicians predict survival and optimize treatment strategy in patients with intrahepatic cholangiocarcinoma (iCCA).

The study, published in Liver International, found that the prognostic model discriminated well in both the training and validation sets. Furthermore, the MRI-based prognostic score was not significantly different from 3 main staging systems for iCCA: the American Joint Commission on Cancer (AJCC) 8th TNM stage, Nathan’s stage, and the MEGNA score.

“As most current staging systems for mass-forming intrahepatic cholangiocarcinoma (MF-iCCA) are based on pathological results, it is difficult to predict post-surgical outcome in the preoperative stage,” the authors wrote. “As our model consists of serum CA 19-9 [carbohydrate antigen 19-9] and three MRI findings and is simple to calculate, it can be easily applied in the clinical practice. Our MRI prognostic score showed comparable performance with conventional staging systems.”

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The prognosis for iCCA patients is typically poor, and most iCCA staging systems are based on pathologic findings, which makes it difficult to predict prognosis or choose a treatment strategy prior to hepatic resection. Given that MRI is known to be an accurate modality for diagnosing liver metastasis, even with small metastatic lesions, the research team aimed to develop an MRI-based prognostic model and compare its performance with that of conventional staging systems.

They enrolled 316 treatment-naïve patients undergoing preoperative MRI and surgical resection for MF-iCCA between 2009 and 2015. In addition to 3 MRI results regarding tumor multiplicity, lymph node metastasis, and bile duct invasion, their model included serum CA 19-9, a known tumor marker and potential survival predictor.

The model permitted the team to preoperatively predict the overall survival of patients with iCCA undergoing liver resection, and it showed comparable discriminatory ability to conventional staging systems, both of which may help optimize treatment strategy.


Rhee H, Choi SH, Park JH, et al. Preoperative magnetic resonance imaging-based prognostic model for mass-forming intrahepatic cholangiocarcinoma. Liver Int. Published online February 13, 2022. doi:10.1111/liv.15196