Intrahepatic cholangiocarcinoma (iCCA) with liver metastases (LM) are 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. This collaborative study including 574 and 4,171 patients from the ENS-CCA and SEER registries confirms that iCCA LM have a significant worse prognosis than other early stages and the authors suggest a novel “M1a stage” defined as liver metastasis: multiple liver lesions, with or without vascular invasion”

(Lamarca A, Santos-Laso A et al. Hepatology.18 October 2020)

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