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. 2007 Mar 7;13(9):1422-6.
doi: 10.3748/wjg.v13.i9.1422.

Long-term outcome and prognostic factors of patients with hilar cholangiocarcinoma

Andreas Weber  1 , Sonja Landrock, Jochen Schneider, Manfred Stangl, Bruno Neu, Peter Born, Meinhard Classen, Thomas Rösch, Roland-M Schmid, Christian Prinz
Affiliations

Long-term outcome and prognostic factors of patients with hilar cholangiocarcinoma

Andreas Weber et al. World J Gastroenterol. .

Abstract

Aim: To evaluate the long-term outcome and prognostic factors of patients with hilar cholangiocarinoma.

Methods: Ninety-six consecutive patients underwent treatment for malignant hilar bile duct tumors during 1995-2005. Of the 96 patients, 20 were initially treated with surgery (n = 2 R0 / n = 18 R1). In non-operated patients, data analysis was performed retrospectively.

Results: Among the 96 patients, 76 were treated with endoscopic transpapillary (ERC, n = 45) and/or percutaneous transhepatic biliary drainage (PTBD, n = 31). The mean survival time of these 76 patients undergoing palliative endoscopic and/or percutaneous drainage was 359 +/- 296 d. The mean survival time of patients with initial bilirubin levels > 10 mg/dL was significantly lower (P < 0.001) than patients with bilirubin levels < 10 mg/dL. The mean survival time of patients with Bismuth stage II (n = 8), III (n = 28) and IV (n = 40) was 496 +/- 300 d, 441 +/- 385 d and 274 +/- 218 d, respectively. Thus, patients with advanced Bismuth stage showed a reduced mean survival time, but the difference was not significant. The type of biliary drainage had no significant beneficial effect on the mean survival time (ERC vs PTBD, P = 0.806).

Conclusion: Initial bilirubin level is a significant prognostic factor for survival of patients. In contrast, age, tumor stage according to the Bismuth-Corlette classification, and types of intervention are not significant prognostic parameters for survival. Palliative treatment with endoscopic or percutaneous biliary drainage is still suboptimal, new diagnostic and therapeutic tools need to be evaluated.

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Figures

Figure 1
Figure 1
ERC/X-ray contrast of the bile duct system in a 57-year old patient with hilar cholangiocarcinoma (Bismuth IV).
Figure 2
Figure 2
Algorithm of treatment strategies.
Figure 3
Figure 3
Kaplan-Meier estimate for survival depending on Bismuth stage at the time of initial diagnosis in 76 (A) initial serum bilirubin levels (B), and endoscopic procedure (ERC vs ERC/PTBD) (C) in 76 non resected patients.
Figure 4
Figure 4
Mean survival depending on patients age in the non resected group (n = 76).
See this image and copyright information in PMC

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