Background: Prognosis with cholangiocarcinoma is determined using clinical parameters perceived to be acceptable predictors of survival. We undertook this study to determine if conventionally accepted clinical prognostic parameters correlate with survival of patients undergoing resection of cholangiocarcinomas.
Methods: From 1988 to 2000, we treated 192 patients with cholangiocarcinomas. Ninety-three patients, 57 males and 36 females, of mean age 66 years ± 11.9, underwent resection of cholangiocarcinomas. Patients were assigned a TNM stage and stratified into groups according to the location of the tumor (intrahepatic, perihilar, and distal). By regression and logistic analysis, age, preoperative bilirubin, location of the tumor, margins of resection, TNM stage, and postoperative chemoradiation therapy were correlated with survival. Data are reported as mean ± STD, when appropriate.
Results: Thirty-four patients had liver resections, 26 had common bile duct excisions, 33 underwent pancreaticoduodenectomies. Mean survival was significantly better in patients who underwent resection compared to patients deemed unresectable (32 months ± 31.6 versus 8 months ± 6.9)(p<0.0001). After resection, linear regression demonstrated that age (p=0.06), preoperative bilirubin (p=0.39), location of tumor (p=0.31), margins of resection (p=0.06), and TNM staging (p=0.25) did not correlate with survival. Only adjuvant chemoradiation correlated with lenght of survival (p=0.005). Multivariate logistic regression showed that age (p=0.63), margins of resection (p=0.28), TNM staging (p=0.98) and postoperative chemoradiation therapy (p=0.98) did not correlate with survival.
Conclusions: As expected, patients with cholangiocarcinomas had significantly longer survival after resection. In patients undergoing resection of cholangiocarcinomas, conventionally accepted prognostic parameters did not correlate significantly with survival. Therefore, conventional prognostic parameters, including anticipation of positive margins at surgery, should not deter an aggressive surgical approach to cholangiocarcinoma.
