Clinical features and survival outcome of locally advanced extrahepatic cholangiocarcinoma

Abstract

Backgrounds/aims: Little is known about clinical features and survival outcome in locally advanced unresectable extrahepatic cholangiocarcinoma (EHC). The aim was to investigate the clinical features and the survival outcome in these patients, and to evaluate the role of palliative resections in locally advanced unresectable EHC.

Methods: Between 1995 and 2007, 280 patients with locally advanced unresectable EHC were identified. Clinical, pathologic, and survival data were investigated. A comparative analysis was done between those who received palliative resection (PR) and those who were not operated on (NR).

Results: The overall median survival of the study population was 10±1 months, and the 3- and 5-year survival rates (YSR) were 8.5% and 2.5%, respectively. The median survival, 3- and 5-YSR of PR were 23 months, 32.1% and 13.1%, respectively. For NR, they were 9 months, 3.9% and 0%, which were significantly worse than PR (p<0.001). In univariate analysis, T classification, N classification, tumor location, palliative resection, adjuvant treatment, chemotherapy, and radiation therapy were factors that showed survival difference between PR and NR. Regional lymph node metastasis (RR, 2.084; 95% CI, 1.491-2.914; p<0.001), non-resections (RR, 2.270; 95% CI, 1.497-3.443; p<0.001), and no chemotherapy (RR, 1.604; 95% CI, 1.095-2.349; p=0.015) were identified as risk factors for poor outcome on multivariate analysis.

Conclusions: Without evidence of systemic disease, palliative resection may provide some survival benefit in selected locally advanced unresectable EHCs and adjuvant treatment may further improve survival outcome.

Keywords: Adjuvant therapy; Cholangiocarcinoma; Extrahepatic; Palliative surgery; Survival.

Fig. 1

A summary of selection of patients eligible for analysis is depicted.

Fig. 2

The survival outcome of palliative resection (PR) was significantly better than that of non-resection (NR).

Fig. 3

Comparison of survival outcomes in T3 shows that palliative resection have survival benefit (A). However, this survival benefit of palliative resection is no longer valid in T4 tumors (B).

Fig. 4

Adjuvant treatment shows significantly improved survival in locally advanced unresectable EHCs (A). Subgroup survival analysis demonstrates that palliative resection is essential to improve the benefit of adjuvant treatment (Adj. Tx) (B).

Fig. 5

Management algorithm for locally advanced EHC is depicted.