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Lamarca A, Santos‐Laso A, Utpatel K, La Casta A, Stock S, Forner A, Adeva J, Folseraas T, Fabris L, Macias RI, Krawczyk M, Krawczyk M, Cardinale V, Braconi C, Alvaro D, Evert M, Banales JM, Valle JW. Liver Metastases of Intrahepatic Cholangiocarcinoma: Implications for an Updated Staging System. Hepatology 2021; 73:2311-2325. [PMID: 33073396 PMCID: PMC8252018 DOI: 10.1002/hep.31598] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 08/04/2020] [Accepted: 09/20/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Intrahepatic cholangiocarcinoma (iCCA) with liver metastases is perceived to have a poor prognosis, but the American Joint Committee on Cancer (AJCC) classifies them as early stage in the absence of lymph nodes or extrahepatic spread. APPROACH AND RESULTS Patients with iCCA from the European Network for the Study of Cholangiocarcinoma (ENS-CCA) and Surveillance, Epidemiology, and End Results (SEER) registries with survival/staging (AJCC v.7) data were eligible. Modified staging was used (mAJCC v.7): group A: stages I-III (excluding T2bN0); group B: stage IVa (excluding T2bN1M0); group C: liver metastases (T2bN0/1); and group D: stage IVb (extrahepatic metastases). Survival analysis (Kaplan-Meier and Cox regression) was performed in an ENS-CCA training cohort (TC) and findings internally (ENS-CCA iVC) and externally (SEER) validated. The aim was to assess whether liver metastases (group C) had a shorter survival compared to other early stages (group A) to propose a modified version of AJCC v.8 (mAJCC v.8). A total of 574 and 4,171 patients from the ENS-CCA and SEER registries were included. Following the new classification, 19.86% and 17.31% of patients from the ENS-CCA and SEER registries were reclassified into group C, respectively. In the ENS-CCA TC, multivariable Cox regression was adjusted for obesity (p = 0.026) and performance status (P < 0.001); patients in group C (HR, 2.53; 95% CI, 1.18-5.42; P = 0.017) had a higher risk of death (vs. group A). Findings were validated in the ENS-CCA iVC (HR, 2.93; 95% CI, 2.04-4.19; P < 0.001) and in the SEER registry (HR, 1.88; 95% CI, 1.68-2.09; P < 0.001). CONCLUSIONS iCCA with liver metastases has a worse outcome than other early stages of iCCA. Given that AJCC v.8 does not take this into consideration, a modification of AJCC v.8 (mAJCC v.8), including "liver metastases: multiple liver lesions, with or without vascular invasion" as an "M1a stage," is suggested.
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Affiliation(s)
- Angela Lamarca
- Medical Oncology/Institute of Cancer SciencesThe Christie NHS Foundation Trust/University of ManchesterManchesterUnited Kingdom
| | - Alvaro Santos‐Laso
- Department of Liver and Gastrointestinal DiseasesBiodonostia Health Research InstituteDonostia University HospitalUniversity of the Basque Country (UPV/EHU)San SebastianSpain
| | - Kirsten Utpatel
- Institute of PathologyUniversity of RegensburgRegensburgGermany
| | - Adelaida La Casta
- Department of Liver and Gastrointestinal DiseasesBiodonostia Health Research InstituteDonostia University HospitalUniversity of the Basque Country (UPV/EHU)San SebastianSpain
| | - Simone Stock
- Institute of PathologyUniversity of RegensburgRegensburgGermany
| | - Alejandro Forner
- BCLC group, Liver UnitHospital Clínic BarcelonaBarcelonaSpain
- National Institute for the Study of Liver and Gastrointestinal Diseases (CIBERehd)The National Institute of Health Carlos IIIMadridSpain
| | - Jorge Adeva
- Department of Medical OncologyHospital Universitario 12 de OctubreMadridSpain
| | - Trine Folseraas
- Section of Gastroenterology and the Norwegian PSC Research CenterDepartment of Transplantation MedicineOslo University HospitalOsloNorway
| | - Luca Fabris
- Department of Molecular MedicineUniversity of PaduaPaduaItaly
| | - Rocio I.R. Macias
- National Institute for the Study of Liver and Gastrointestinal Diseases (CIBERehd)The National Institute of Health Carlos IIIMadridSpain
- Experimental Hepatology and Drug Targeting (HEVEPHARM) groupUniversity of SalamancaIBSALSalamancaSpain
| | - Marcin Krawczyk
- Department of Medicine IISaarland University Medical CentreSaarland UniversityHomburgGermany
- Laboratory of Metabolic Liver DiseasesCentre for Preclinical ResearchDepartment of General, Transplant and Liver SurgeryMedical University of WarsawWarsawPoland
| | - Marek Krawczyk
- Department of General, Transplant and Liver SurgeryMedical University of WarsawWarsawPoland
| | | | - Chiara Braconi
- Medical OncologyThe University of GlasgowGlasgowUnited Kingdom
| | | | - Matthias Evert
- Institute of PathologyUniversity of RegensburgRegensburgGermany
| | - Jesus M. Banales
- Department of Liver and Gastrointestinal DiseasesBiodonostia Health Research InstituteDonostia University HospitalUniversity of the Basque Country (UPV/EHU)San SebastianSpain
- National Institute for the Study of Liver and Gastrointestinal Diseases (CIBERehd)The National Institute of Health Carlos IIIMadridSpain
- IKERBASQUEBasque Foundation for ScienceBilbaoSpain
| | - Juan W. Valle
- Medical Oncology/Institute of Cancer SciencesThe Christie NHS Foundation Trust/University of ManchesterManchesterUnited Kingdom
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Caballero‐Camino FJ, Rivilla I, Herraez E, Briz O, Santos‐Laso A, Izquierdo‐Sanchez L, Lee‐Law PY, Rodrigues PM, Munoz‐Garrido P, Jin S, Peixoto E, Richard S, Gradilone SA, Perugorria MJ, Esteller M, Bujanda L, Marin JJ, Banales JM, Cossío FP. Synthetic Conjugates of Ursodeoxycholic Acid Inhibit Cystogenesis in Experimental Models of Polycystic Liver Disease. Hepatology 2021; 73:186-203. [PMID: 32145077 PMCID: PMC7891670 DOI: 10.1002/hep.31216] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 02/11/2020] [Accepted: 02/23/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIMS Polycystic liver diseases (PLDs) are genetic disorders characterized by progressive development of symptomatic biliary cysts. Current surgical and pharmacological approaches are ineffective, and liver transplantation represents the only curative option. Ursodeoxycholic acid (UDCA) and histone deacetylase 6 inhibitors (HDAC6is) have arisen as promising therapeutic strategies, but with partial benefits. APPROACH AND RESULTS Here, we tested an approach based on the design, synthesis, and validation of a family of UDCA synthetic conjugates with selective HDAC6i capacity (UDCA-HDAC6i). Four UDCA-HDAC6i conjugates presented selective HDAC6i activity, UDCA-HDAC6i #1 being the most promising candidate. UDCA orientation within the UDCA-HDAC6i structure was determinant for HDAC6i activity and selectivity. Treatment of polycystic rats with UDCA-HDAC6i #1 reduced their hepatomegaly and cystogenesis, increased UDCA concentration, and inhibited HDAC6 activity in liver. In cystic cholangiocytes UDCA-HDAC6i #1 restored primary cilium length and exhibited potent antiproliferative activity. UDCA-HDAC6i #1 was actively transported into cells through BA and organic cation transporters. CONCLUSIONS These UDCA-HDAC6i conjugates open a therapeutic avenue for PLDs.
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Affiliation(s)
- Francisco J. Caballero‐Camino
- Department of Organic Chemistry ICenter of Innovation in Advanced Chemistry (ORFEO‐CINQA)University of the Basque Country/Euskal Herriko Unibertsitatea (UPV/EHU)Donostia International Physics Center (DIPC)Donostia‐San SebastianSpain,Department of Liver and Gastrointestinal DiseasesBiodonostia Health Research InstituteDonostia University HospitalUPV/EHUDonostia‐San SebastianSpain
| | - Ivan Rivilla
- Department of Organic Chemistry ICenter of Innovation in Advanced Chemistry (ORFEO‐CINQA)University of the Basque Country/Euskal Herriko Unibertsitatea (UPV/EHU)Donostia International Physics Center (DIPC)Donostia‐San SebastianSpain
| | - Elisa Herraez
- Experimental Hepatology and Drug Targeting (HEVEFARM)Biomedical Research Institute of Salamanca (IBSAL)University of SalamancaSalamancaSpain,National Institute for the Study of Liver and Gastrointestinal Diseases (CIBERehd)Carlos III National Institute of HealthMadridSpain
| | - Oscar Briz
- Experimental Hepatology and Drug Targeting (HEVEFARM)Biomedical Research Institute of Salamanca (IBSAL)University of SalamancaSalamancaSpain,National Institute for the Study of Liver and Gastrointestinal Diseases (CIBERehd)Carlos III National Institute of HealthMadridSpain
| | - Alvaro Santos‐Laso
- Department of Liver and Gastrointestinal DiseasesBiodonostia Health Research InstituteDonostia University HospitalUPV/EHUDonostia‐San SebastianSpain
| | - Laura Izquierdo‐Sanchez
- Department of Liver and Gastrointestinal DiseasesBiodonostia Health Research InstituteDonostia University HospitalUPV/EHUDonostia‐San SebastianSpain,National Institute for the Study of Liver and Gastrointestinal Diseases (CIBERehd)Carlos III National Institute of HealthMadridSpain
| | - Pui Y. Lee‐Law
- Department of Liver and Gastrointestinal DiseasesBiodonostia Health Research InstituteDonostia University HospitalUPV/EHUDonostia‐San SebastianSpain
| | - Pedro M. Rodrigues
- Department of Liver and Gastrointestinal DiseasesBiodonostia Health Research InstituteDonostia University HospitalUPV/EHUDonostia‐San SebastianSpain
| | - Patricia Munoz‐Garrido
- Department of Liver and Gastrointestinal DiseasesBiodonostia Health Research InstituteDonostia University HospitalUPV/EHUDonostia‐San SebastianSpain
| | - Sujeong Jin
- The Hormel InstituteUniversity of MinnesotaAustinMN,Masonic Cancer CenterUniversity of MinnesotaMinneapolisMN
| | - Estanislao Peixoto
- The Hormel InstituteUniversity of MinnesotaAustinMN,Masonic Cancer CenterUniversity of MinnesotaMinneapolisMN
| | - Seth Richard
- The Hormel InstituteUniversity of MinnesotaAustinMN,Masonic Cancer CenterUniversity of MinnesotaMinneapolisMN
| | - Sergio A. Gradilone
- The Hormel InstituteUniversity of MinnesotaAustinMN,Masonic Cancer CenterUniversity of MinnesotaMinneapolisMN
| | - Maria J. Perugorria
- Department of Liver and Gastrointestinal DiseasesBiodonostia Health Research InstituteDonostia University HospitalUPV/EHUDonostia‐San SebastianSpain,National Institute for the Study of Liver and Gastrointestinal Diseases (CIBERehd)Carlos III National Institute of HealthMadridSpain
| | - Manel Esteller
- Josep Carreras Leukaemia Research Institute (IJC)BarcelonaSpain,Centro de Investigacion Biomedica en Red Cancer (CIBERONC)MadridSpain,Institucio Catalana de Recerca i Estudis Avançats (ICREA)BarcelonaSpain,Physiological Sciences DepartmentSchool of Medicine and Health SciencesUniversity of Barcelona (UB)BarcelonaSpain
| | - Luis Bujanda
- Department of Liver and Gastrointestinal DiseasesBiodonostia Health Research InstituteDonostia University HospitalUPV/EHUDonostia‐San SebastianSpain,National Institute for the Study of Liver and Gastrointestinal Diseases (CIBERehd)Carlos III National Institute of HealthMadridSpain
| | - Jose J.G. Marin
- Experimental Hepatology and Drug Targeting (HEVEFARM)Biomedical Research Institute of Salamanca (IBSAL)University of SalamancaSalamancaSpain,National Institute for the Study of Liver and Gastrointestinal Diseases (CIBERehd)Carlos III National Institute of HealthMadridSpain
| | - Jesus M. Banales
- Department of Liver and Gastrointestinal DiseasesBiodonostia Health Research InstituteDonostia University HospitalUPV/EHUDonostia‐San SebastianSpain,National Institute for the Study of Liver and Gastrointestinal Diseases (CIBERehd)Carlos III National Institute of HealthMadridSpain,IKERBASQUEBasque Foundation for ScienceBilbaoSpain
| | - Fernando P. Cossío
- Department of Organic Chemistry ICenter of Innovation in Advanced Chemistry (ORFEO‐CINQA)University of the Basque Country/Euskal Herriko Unibertsitatea (UPV/EHU)Donostia International Physics Center (DIPC)Donostia‐San SebastianSpain
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Banales JM, Iñarrairaegui M, Arbelaiz A, Milkiewicz P, Muntané J, Muñoz‐Bellvis L, La Casta A, Gonzalez LM, Arretxe E, Alonso C, Martínez‐Arranz I, Lapitz A, Santos‐Laso A, Avila MA, Martínez‐Chantar ML, Bujanda L, Marin JJ, Sangro B, Macias RI. Serum Metabolites as Diagnostic Biomarkers for Cholangiocarcinoma, Hepatocellular Carcinoma, and Primary Sclerosing Cholangitis. Hepatology 2019; 70:547-562. [PMID: 30325540 PMCID: PMC6767196 DOI: 10.1002/hep.30319] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 10/06/2018] [Indexed: 12/12/2022]
Abstract
Early and differential diagnosis of intrahepatic cholangiocarcinoma (iCCA) and hepatocellular carcinoma (HCC) by noninvasive methods represents a current clinical challenge. The analysis of low-molecular-weight metabolites by new high-throughput techniques is a strategy for identifying biomarkers. Here, we have investigated whether serum metabolome can provide useful biomarkers in the diagnosis of iCCA and HCC and could discriminate iCCA from HCC. Because primary sclerosing cholangitis (PSC) is a risk factor for CCA, serum metabolic profiles of PSC and CCA have also been compared. The analysis of the levels of lipids and amino acids in the serum of patients with iCCA, HCC, and PSC and healthy individuals (n = 20/group) showed differential profiles. Several metabolites presented high diagnostic value for iCCA versus control, HCC versus control, and PSC versus control, with areas under the receiver operating characteristic curve (AUC) greater than those found in serum for the nonspecific tumor markers carbohydrate antigen 19-9 (CA 19-9) and alpha-fetoprotein (AFP), commonly used to help in the diagnosis of iCCA and HCC, respectively. The development of an algorithm combining glycine, aspartic acid, SM(42:3), and SM(43:2) permitted to accurately differentiate in the diagnosis of both types of tumors (biopsy-proven). The proposed model yielded 0.890 AUC, 75% sensitivity, and 90% specificity. Another algorithm by combination of PC(34:3) and histidine accurately permitted to differentiate PSC from iCCA, with an AUC of 0.990, 100% sensitivity, and 70% specificity. These results were validated in independent cohorts of 14-15 patients per group and compared with profiles found in patients with nonalcoholic fatty liver disease/nonalcoholic steatohepatitis. Conclusion: Specific changes in serum concentrations of certain metabolites are useful to differentiate iCCA from HCC or PSC, and could help in the early diagnosis of these diseases.
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Affiliation(s)
- Jesus M. Banales
- Department of Liver and Gastrointestinal DiseasesBiodonostia Research Institute, Donostia University Hospital, University of the Basque Country (UPV/EHU)San SebastianSpain,National Institute for the Study of Liver and Gastrointestinal Diseases (CIBERehd, Carlos III Health Institute)MadridSpain,IKERBASQUEBasque Foundation for ScienceBilbaoSpain
| | - Mercedes Iñarrairaegui
- National Institute for the Study of Liver and Gastrointestinal Diseases (CIBERehd, Carlos III Health Institute)MadridSpain,Liver UnitClínica Universidad de Navarra‐IDISNAPamplonaSpain
| | - Ander Arbelaiz
- Department of Liver and Gastrointestinal DiseasesBiodonostia Research Institute, Donostia University Hospital, University of the Basque Country (UPV/EHU)San SebastianSpain
| | - Piotr Milkiewicz
- Liver and Internal Medicine Unit, Department of General, Transplant and Liver SurgeryMedical University of WarsawWarsawPoland
| | - Jordi Muntané
- National Institute for the Study of Liver and Gastrointestinal Diseases (CIBERehd, Carlos III Health Institute)MadridSpain,Department of General Surgery “Virgen del Rocío” University Hospital/IBiS/CSIC/University of SevilleSevilleSpain
| | - Luis Muñoz‐Bellvis
- Service of General and Gastrointestinal SurgeryUniversity Hospital of Salamanca, Biomedical Research Institute of Salamanca (IBSAL), CIBERONCSalamancaSpain
| | - Adelaida La Casta
- Department of Liver and Gastrointestinal DiseasesBiodonostia Research Institute, Donostia University Hospital, University of the Basque Country (UPV/EHU)San SebastianSpain
| | - Luis M. Gonzalez
- Service of General and Gastrointestinal SurgeryUniversity Hospital of Salamanca, Biomedical Research Institute of Salamanca (IBSAL), CIBERONCSalamancaSpain
| | | | | | | | - Ainhoa Lapitz
- Department of Liver and Gastrointestinal DiseasesBiodonostia Research Institute, Donostia University Hospital, University of the Basque Country (UPV/EHU)San SebastianSpain
| | - Alvaro Santos‐Laso
- Department of Liver and Gastrointestinal DiseasesBiodonostia Research Institute, Donostia University Hospital, University of the Basque Country (UPV/EHU)San SebastianSpain
| | - Matias A. Avila
- National Institute for the Study of Liver and Gastrointestinal Diseases (CIBERehd, Carlos III Health Institute)MadridSpain,Program of Hepatology, Center for Applied Medical Research (CIMA)University of Navarra‐IDISNAPamplonaSpain
| | - Maria L. Martínez‐Chantar
- National Institute for the Study of Liver and Gastrointestinal Diseases (CIBERehd, Carlos III Health Institute)MadridSpain,CIC bioGUNEBizkaia Technology ParkDerioSpain
| | - Luis Bujanda
- Department of Liver and Gastrointestinal DiseasesBiodonostia Research Institute, Donostia University Hospital, University of the Basque Country (UPV/EHU)San SebastianSpain,National Institute for the Study of Liver and Gastrointestinal Diseases (CIBERehd, Carlos III Health Institute)MadridSpain
| | - Jose J.G. Marin
- National Institute for the Study of Liver and Gastrointestinal Diseases (CIBERehd, Carlos III Health Institute)MadridSpain,Experimental Hepatology and Drug Targeting (HEVEFARM)University of Salamanca, Biomedical Research Institute of Salamanca (IBSAL)SalamancaSpain
| | - Bruno Sangro
- National Institute for the Study of Liver and Gastrointestinal Diseases (CIBERehd, Carlos III Health Institute)MadridSpain,Liver UnitClínica Universidad de Navarra‐IDISNAPamplonaSpain
| | - Rocio I.R. Macias
- National Institute for the Study of Liver and Gastrointestinal Diseases (CIBERehd, Carlos III Health Institute)MadridSpain,Experimental Hepatology and Drug Targeting (HEVEFARM)University of Salamanca, Biomedical Research Institute of Salamanca (IBSAL)SalamancaSpain
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