Prognostic factors and long-term outcomes of hilar cholangiocarcinoma:A single-institution experience in China

AIM: To evaluate the prognostic factors of hilar cholangiocarcinoma in a large series of patients in a single institution.METHODS: Eight hundred and fourteen patients with a diagnosis of hilar cholangiocarcinoma that were evaluated and treated between 1990 and 2014, of which 381 patients underwent c...

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Published in:World journal of gastroenterology : WJG 2016-02, Vol.22 (8), p.2601-2610
Main Authors: Hu, Hai-Jie, Mao, Hui, Shrestha, Anuj, Tan, Yong-Qiong, Ma, Wen-Jie, Yang, Qin, Wang, Jun-Ke, Cheng, Nan-Sheng, Li, Fu-Yu
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Bile Duct Neoplasms - mortality
Bile Duct Neoplasms - pathology
Bile Duct Neoplasms - surgery
Biliary Tract Surgical Procedures - adverse effects
Biliary Tract Surgical Procedures - mortality
Cell Differentiation
Chi-Square Distribution
China
cholangiocarcinoma
Prognosis
Surgical
Databases, Factual
Disease-Free Survival
Hepatectomy - adverse effects
Hepatectomy - mortality
Hilar
Humans
Kaplan-Meier Estimate
Klatskin Tumor - mortality
Klatskin Tumor - secondary
Klatskin Tumor - surgery
Logistic Models
Lymphatic Metastasis
margin
Middle Aged
Multivariate Analysis
Neoplasm Invasiveness
Neoplasm Staging
Neoplasm, Residual
Odds Ratio
outcome
Survival
Tumor-free
Palliative Care
Patient Selection
Retrospective Cohort Study
Retrospective Studies
Risk Factors
Time Factors
Treatment Outcome
Young Adult
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Summary:AIM: To evaluate the prognostic factors of hilar cholangiocarcinoma in a large series of patients in a single institution.METHODS: Eight hundred and fourteen patients with a diagnosis of hilar cholangiocarcinoma that were evaluated and treated between 1990 and 2014, of which 381 patients underwent curative surgery, were included in this study. Potential factors associated with overall survival(OS) and disease-free survival(DFS) were evaluated by univariate and multivariate analyses.RESULTS: Curative surgery provided the best long-term survival with a median OS of 26.3 mo. The median DFS was 18.1 mo. Multivariate analysis showed that patients with tumor size > 3 cm [hazard ratio(HR) = 1.482, 95%CI: 1.127-1.949; P = 0.005], positive nodal disease(HR = 1.701, 95%CI: 1.346-2.149; P < 0.001), poor differentiation(HR = 2.535, 95%CI: 1.839-3.493; P < 0.001), vascular invasion(HR = 1.542, 95%CI: 1.082-2.197; P = 0.017), and positive margins(HR = 1.798, 95%CI: 1.314-2.461; P < 0.001) had poor OS outcome. The independent factors for DFS were positive nodal disease(HR = 3.383, 95%CI: 2.633-4.348; P < 0.001), poor differentiation(HR = 2.774, 95%CI: 2.012-3.823; P < 0.001), vascular invasion(HR = 2.136, 95%CI: 1.658-3.236; P < 0.001), and positive margins(HR = 1.835, 95%CI: 1.256-2.679; P < 0.001). Multiple logistic regression analysis showed that caudate lobectomy [odds ratio(OR) = 9.771, 95%CI: 4.672-20.433; P < 0.001], tumor diameter(OR = 3.772, 95%CI: 1.914-7.434; P < 0.001), surgical procedures(OR = 10.236, 95%CI: 4.738-22.116; P < 0.001), American Joint Committee On Cancer T stage(OR = 2.010, 95%CI: 1.043-3.870; P = 0.037), and vascular invasion(OR = 2.278, 95%CI: 0.997-5.207; P = 0.051) were independently associated with tumorfree margin, and surgical procedures could indirectly affect survival outcome by influencing the tumor resection margin. CONCLUSION: Tumor margin, tumor differentiation, vascular invasion, and lymph node status were independent factors for OS and DFS. Surgical procedures can indirectly affect survival outcome by influencing the tumor resection margin.
ISSN:1007-9327
2219-2840
DOI:10.3748/wjg.v22.i8.2601