Characteristics of “Very Early” Intrahepatic Cholangiocarcinoma Undergoing Liver Resection and Its Relationship With Carbohydrate Antigen 19‐9
Bibliographic record
Abstract
INTRODUCTION: The concept of "very early" ICC ( ≤ 2 cm, single tumor) has been introduced in the context of LT. Due to the limited number of patients in this subset, the characteristics and long-term outcomes have been ill-defined. We sought to assess long-term outcomes of very early ICC patients undergoing liver resection using a large, multi-institutional database. METHODS: Patients who underwent curative-intent hepatectomy for ICC between 1993 and 2023 were identified from the International Intrahepatic Cholangiocarcinoma Study Group database. Multivariable Cox regression analysis was performed to identify the risk factors related to overall survival (OS) and recurrence-free survival (RFS). RESULTS: Among 1868 ICC patients, 86 (4.6%) met the criteria for very early ICC. While patient and tumor characteristics were similar between very early and non-very early ICC, 1-, 3-, and 5-year OS among patients with very early ICC was 92.3% (IQR 86.6-98.4), 72.6% (IQR 62.7-84.1), and 58.0% (IQR 45.9-73.5), respectively, versus 80.8% (IQR 78.9-82.7), 51.0% (IQR 48.4-53.8), and 38.9% (IQR 36.1-41.9), respectively, among non-very early ICC patients (p < 0.01). On multivariable Cox regression analysis, elevated CA19-9 levels were associated with worse OS (HR 3.05, IQR 1.28-7.30, p = 0.01) and RFS (HR 2.88, IQR 1.24-6.66, p = 0.01). Very early ICC patients with higher CA19-9 level were more likely to have metastatic nodal disease (N1: ≥ 40 U/mL n = 11, 40.7%, vs. n = 3, 5.1%, p < 0.001), microvascular invasion ( ≥ 40 U/mL n = 10, 37.0%, vs. n = 4, 6.8%, p < 0.001), and major vascular invasion ( ≥ 40 U/mL n = 8, 29.6%, vs. n = 2, 3.4%, p < 0.01). CONCLUSIONS: Very early ICC was associated with favorable long-term outcomes; however, elevated CA19-9 levels identified a subgroup with a much worse prognosis and more aggressive tumor features. CA19-9 may help guide perioperative treatment decisions, including additional treatment after surgical interventions.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".