Preoperative evaluation with T-staging system for hilar cholangiocarcinoma

Abstract

Aim: To investigate the clinical value of T-staging system in the preoperative assessment of hilar cholangiocarcinoma.

Methods: From March 1993 to January 2006, 85 patients who had cholangiocarcinoma diagnosed by operative tissue-biopsy were placed into one of three stages based on the new T-staging system, and it was evaluated the resectability and survival correlated with T-staging.

Results: The likelihood of resection and achieving tumor-free margin decreased progressively with increasing T stage (P < 0.05). The cumulative 1-year survival rates of T1, T2 and T3 patients were 71.8%, 50.8% and 12.9% respectively, and the cumulative 3-year survival rate was 34.4%, 18.2% and 0% respectively; the survival of different stage patients differed markedly (P < 0.001). Median survival in the hepatic resection group was greater than in the group that did not undergo hepatic resection (28 mo vs 18 mo; P < 0.05). The overall accuracy for combined MRCP and color Doppler Ultrasonagraphy detecting disease was higher than that of combined using CT and color Doppler Ultrasonagraphy (91.4% vs 68%; P < 0.05 ). And it was also higher in detecting port vein involvement (90% vs 54.5%; P < 0.05).

Conclusion: The proposed staging system for hilar cholangiocarcinoma can accurately predict resectability, the likelihood of metastatic disease, and survival. A concomitant partial hepatectomy would help to attain curative resection and the possibility of long-term survival. MRCP/MRA coupled with color Doppler Ultrasonagraphy was necessary for preoperative evaluation of hilar cholangiocarcinoma.

Figure 1

Kaplan-Meier survival analysis stratified by T stage. T stages seemed to be correlated with the survival time (χ² = 37.65, P < 0.001), and the survival time decreased progressively with increasing T staging. The cumulative 1-year survival rates of T1, T2 and T3 patients were 71.8%, 50.8% and 12.9%, respectively, and the cumulative 3-year survival rate was 34.4%,18.2% and 0%, respectively, the survival of different stage patients differed markedly (P < 0.001).