Predicting overall and recurrence‐free survival in patients with intrahepatic cholangiocarcinoma using the MEGNA score: A multi‐institutional analysis

MEGNA is a prognostic scoring system for intrahepatic cholangiocarcinoma (ICC) based on tumor multifocality, extension, grade, lymph node positivity, and age. We sought to assess its predictive ability for overall survival (OS) and recurrence-free survival (RFS).Patients who underwent curative-intent liver resection for ICC between 2000 and 2020 were identified using an international multi-institutional database. Multivariate Cox regression was utilized to identify prognostic factors.Among 800 patients with a median age of 58 years (interquartile range [IQR]: 50-68), the majority of patients were male (n = 467, 58.4%). 5-year OS was 40.5%, while 5-year RFS was 27.9%. The prognostic ability of MEGNA score (c-index = 0.60) was similar to AJCC (c-index = 0.58) and TBS (c-index = 0.58). MEGNA was an independent prognostic factor for OS (0: Reference; I: hazard ratio [HR]: 1.39, 95% confidence interval [CI]: 1.05-1.84; II: HR: 2.15, 95% CI: 1.57-2.96; ≥III: HR: 2.02, 95% CI: 1.33-3.06; all p < 0.05), alongside high CA 19-9, positive resection margins, and major vascular invasion (all p < 0.05). Furthermore, although MEGNA was not able to predict RFS, high CA 19-9 and microvascular invasion were independently associated with worse RFS.MEGNA score was an independent prognostic factor for OS. However, its prognostic ability was modest and comparable to existing systems such as AJCC eigth edition and TBS.