Satellite lesions versus intrahepatic metastasis in multifocal intrahepatic cholangiocarcinoma: Prognostic impact and genomic profiling
Bibliographic record
Abstract
BACKGROUND AND AIMS: Multifocal intrahepatic cholangiocarcinoma (ICC) is typically categorized as satellite lesions (SL) or intrahepatic metastasis (IM). Clinical staging and prognostic significance of multifocal ICC are topics of debate. APPROACH AND RESULTS: ICC patients with solitary or multifocal tumors undergoing curative-intent surgical resection were identified from an international multi-institutional database. SL and IM were classified according to distribution patterns. Among 1064 patients included in the cohort, 358 had multifocal tumors that were defined as IM (n=95) or SL (n=263). Isolated AJCC stage II of multifocal ICC disease was associated with shorter overall (OS) (median: 26.1 vs. 60.0 mo, p <0.001) and disease-free survival (DFS) (median DFS: 9.8 vs. 25.0 mo, p <0.01) than solitary tumors within stage II, yet had a comparable prognosis as stage III disease. Patients with IM or SL had comparable OS and DFS (both p >0.1), regardless of tumor number status. Genomic profiling demonstrated a highly concordant mutational landscape of IM and SL in 24 multifocal ICC patients. Phylogenetic and evolutionary trajectory analysis supported that multifocal lesions with different distribution patterns were of the same origin, derived from the corresponding primary tumors. In addition, single-nucleus RNA sequencing revealed that both IM and SL harbored increased levels of copy number variations compared with the primary lesion, indicative of malignant progression. CONCLUSIONS: Multifocal ICC should be categorized as AJCC stage III disease regardless of IM and SL patterns. Both SL and IM are clonally derived from the primary ICC tumor and represent metastatic progression with poor long-term survival.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 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) | 0.000 | 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 teacher head, 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".