Natural History and Prognostic Factors of Advanced Cholangiocarcinoma without Surgery, Chemotherapy, or Radiotherapy: A Large-Scale Observational Study

Abstract

Background/aims: We aimed to evaluate survival time and prognostic factors in patients with advanced unresectable cholangiocarcinoma who have not received surgery, chemotherapy, or radiotherapy.

Methods: A total of 1,377 patients, who were diagnosed with primary cholangiocarcinoma between 1996 and 2002, were reviewed retrospectively according to the following inclusion criteria: histologically proven primary adenocarcinoma arising from the bile-duct epithelium, advanced unresectable stages, no severe comorbidity that can affect survival time, and no history of surgery, chemotherapy, or radiotherapy.

Results: Of the 1,377 cases reviewed, 330 patients complied with the inclusion criteria and were thus eligible to participate in this study; 203 had intrahepatic cholangiocarcinoma and 127 had hilar cholangiocarcinoma. The overall survival time of the entire cohort (n=330) was median 3.9 months (range; 0.2 to 67.1). The survival time was significantly shorter in the intrahepatic cholangiocarcinoma group (3.0+/-5.3 months) than in the hilar cholangiocarcinoma group (5.9+/-10.1 months; Kaplan-Meier survival analysis). Multivariate analysis revealed that distant metastasis was a poor prognostic factor for intrahepatic cholangiocarcinoma (p< 0.001), baseline serum albumin >3.0 g/dL was a favorable prognostic factor (p=0.02), and baseline serum carcinoembryonic antigen level >30 ng/mL was a poor prognostic factor for hilar cholangiocarcinoma (p=0.01).

Conclusions: The median survival of advanced unresectable cholangiocarcinoma is dismal.

Keywords: Carcinoembryonic antigen; Cholangiocarcinoma; Natural history.

Fig. 1

Study population. Between 1996 and 2002, 1,377 patients were diagnosed with cholangiocarcinoma at our institute; 330 of these patients complied with the inclusion criteria and could thus be included in the study. ^*Although some cases were clinically operable, surgery was not performed due to the patients' refusal.

Fig. 2

Survival graphs of advanced unresectable cholangiocarcinoma. The overall median survival time for all cholangiocarcinoma patients (n=330) was 3.9 months. The median survival time was shorter for those with intrahepatic cholangiocarcinoma (3 months) than for those with hilar cholangiocarcinoma (5.9 months; p<0.001).