Prognostic Factors After Surgical Resection for Intrahepatic, Hilar, and Distal Cholangiocarcinoma

• Published in: Annals of surgical oncology Vol. 18; no. 3; pp. 651 - 658
• Main Authors: Murakami, Yoshiaki, Uemura, Kenichiro, Sudo, Takeshi, Hashimoto, Yasushi, Nakashima, Akira, Kondo, Naru, Sakabe, Ryutaro, Ohge, Hiroki, Sueda, Taijiro
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01-03-2011; Springer Nature B.V
• Subjects: Adult; Aged; Aged, 80 and over; Antimetabolites, Antineoplastic - therapeutic use; Bile Duct Neoplasms - drug therapy; Bile Duct Neoplasms - mortality; Bile Duct Neoplasms - surgery; Bile Ducts, Intrahepatic - drug effects; Bile Ducts, Intrahepatic - surgery; Chemotherapy, Adjuvant; Cholangiocarcinoma - drug therapy; Cholangiocarcinoma - mortality; Cholangiocarcinoma - surgery; Combined Modality Therapy; Deoxycytidine - analogs & derivatives; Deoxycytidine - therapeutic use; Female; Hepatobiliary Tumors; Humans; Liver Neoplasms - drug therapy; Liver Neoplasms - mortality; Liver Neoplasms - surgery; Lymphatic Metastasis; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Recurrence, Local - drug therapy; Neoplasm Recurrence, Local - mortality; Neoplasm Recurrence, Local - surgery; Neoplasm Staging; Oncology; Retrospective Studies; Surgery; Surgical Oncology; Survival Rate; Treatment Outcome; Hilar Cholangiocarcinoma; Gemcitabine; Biliary Tract Cancer; Adjuvant Chemotherapy; Cholangiocarcinoma
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-010-1325-4

Background
The prognosis of patients with cholangiocarcinoma is unsatisfactory. Therefore, evaluation of prognostic factors and establishment of new therapeutic strategies are needed to improve their long-term survival. The aim of this study was to identify useful prognostic factors for patients with intrahepatic, hilar, and distal cholangiocarcinoma.
Materials and Methods
Records of 127 patients with cholangiocarcinoma (21 with intrahepatic cholangiocarcinoma, 50 with hilar cholangiocarcinoma, and 56 with distal cholangiocarcinoma) who underwent surgical resection were reviewed retrospectively. Relationships between survival and clinicopathological factors including patient demographics and tumor characteristics were evaluated using univariate and multivariate analysis.
Results
For all 127 patients, overall 1-, 3-, 5-year survival rates were 80, 51, and 40%, respectively. Univariate analysis revealed that adjuvant chemotherapy (
P
 = .049), tumor differentiation (
P
 = .014), lymph node metastasis (
P
 < .001), surgical margin status (
P
 < .001), UICC pT factor (
P
 < .001), and UICC stage (
P
 < .001) were associated significantly with survival. UICC pT factor (
P
 = .007), adjuvant chemotherapy (
P
 = .009), surgical margin status (
P
 = .012), and lymph node metastasis (
P
= .014) remained independently associated with long-term survival by multivariate analysis. The 5-year survival rates of patients with or without positive surgical margins were 13 and 49%, respectively. The 5-year survival rates of patients treated with or without adjuvant chemotherapy were 47 and 36%, respectively.
Conclusions
R0 resection and adjuvant chemotherapy may be mandatory to achieve long-term survival for patients with cholangiocarcinoma.