Assessment of clinical outcomes of advanced hilar cholangiocarcinoma

作     者：Kang-Jie Chen Fu-Chun Yang Yun-Sheng Qin Jing Jin Shu-Sen Zheng 

作者机构：Division of Hepatobiliary Pancreatic Surgery First Affiliated Hospital Zhejiang University School of Medicine 

出 版 物：《Hepatobiliary & Pancreatic Diseases International》 (国际肝胆胰疾病杂志（英文版）)

年 卷 期：2018年第17卷第2期

页      面：155-162页

核心收录：

学科分类：1002[医学-临床医学] 10[医学] 

基　　金：supported by grants from the 12th Five-Year major project of the transformation of the primary health appropri-ate technology in Zhejiang Province the National Natural Science Foundation for Young Scientists of China(81402350) the Natural Science Foundation for Young Scientists of Zhejiang Province(LQ13H160001) 

主　　题：Hilar cholangiocarcinoma Hepatic artery resection Preoperative biliary drainage Prognostic factors 

摘      要：Background: Low resectability and poor survival outcome are common for hilar cholangiocarcinoma(HCCA), especially in advanced stages. The present study was to assess the clinical outcome of advanced HCCA, focusing on therapeutic modalities, survival analysis and prognostic assessment.Methods: Clinical data of 176 advanced HCCA patients who had been treated in our hospital between January 2013 and December 2015 were analyzed retrospectively. Prognostic effects of clinicopathological factors were explored by univariate and multivariate analysis. Survival predictors were evaluated by the receiver operating characteristic(ROC) curve.Results: The 3-year overall survival rate was 13% for patients with advanced HCCA. Preoperative total bilirubin(P = 0.009), hepatic artery invasion(P = 0.014) and treatment modalities(P = 0.020) were independent prognostic factors on overall survival. A model combining these independent prognostic factors(area under ROC curve: 0.748; 95% CI: 0.678–0.811; sensitivity: 82.3%, specificity: 53.5%) was highly predictive of tumor death. After R0 resection, the 3-year overall survival was up to 38%. Preoperative total bilirubin was still an independent negative factor, but not for hepatic artery invasion.Conclusions: Surgery is still the best treatment for advanced HCCA. Preoperative biliary drainage should be performed in highly-jaundiced patients to improve survival. Prediction of survival is improved significantly by a model that incorporates preoperative total bilirubin, hepatic artery invasion and treatment modalities.