Impact of medical and surgical intervention on survival in patients with cholangiocarcinoma

Table 4 Univariate and stepwise analysis for overall survival n (%)

		Univariate hazard ratio (95%CI)	Stepwise hazard ratio (95%CI)
Age1 (yr)
18-49	107 (13.0)	1.00 (reference)	1.00 (reference)
50-64	230 (27.9)	1.43 (1.11-1.85)	1.64 (1.27-2.13)
65-79	327 (39.6)	1.40 (1.10-1.78)	1.47 (1.15-1.89)
≥ 80	161 (19.5)	2.19 (1.68-2.86)	1.85 (1.40-2.46)
Sex1
Men	390 (47.3)	1.00 (reference)
Women	435 (52.7)	1.02 (0.88-1.18)
Race
Non-hispanic white	373 (45.2)	1.00 (reference)
Ethnicity1
Black	64 (7.8)	1.50 (1.14-1.97)
Hispanic white	215 (26.1)	1.04 (0.87-1.24)
Other	170 (20.6)	1.00 (0.82-1.21)
Socioeconomic status1
Highest	184 (22.3)	1.00 (reference)	1.00 (reference)
Middle	497 (60.2)	1.25 (1.04-1.49)	1.18 (0.98-1.41)
Lowest	144 (17.5)	1.61 (1.28-2.03)	1.52 (1.20-1.92)
Grade
Well differentiated	52 (6.3)	1.00 (reference)
Moderately differentiated	99 (12.0)	1.05 (0.72-1.53)
Poorly differentiated	135 (16.4)	1.61 (1.13-2.29)
Undifferentiated	8 (1.0)	2.96 (1.38-6.32)
Unknown	531 (64.4)	1.71 (1.24-2.35)
Tumor size (cm)
≤ 5	95 (11.5)	1.00 (reference )
> 5	94 (11.4)	1.03 (0.76-1.39)
T Stage
T1	150 (18.2)	1.00 (reference)
T2	28 (3.4)	0.91 (0.57-1.47)
T3a	64 (7.8)	1.10 (0.80-1.51)
T3b	13 (1.6)	1.37 (0.72-2.63)
T4	198 (24)	2.23 (1.76-2.83)
TX	372 (45.1)	1.85 (1.50-2.29)
N stage
N0	278 (33.7)	1.00 (reference )
N1	77 (9.3)	1.62 (1.24-2.12)
NX	470 (57)	1.76 (1.50-2.07)
AJCC7 group1
I	93 (11.3)	1.00 (reference)	1.00 (reference)
II	15 (1.8)	0.80 (0.41-1.56)	1.07 (0.54-2.09)
III	79 (9.6)	1.37 (0.98-1.91)	1.31 (0.93-1.84)
IV	204 (24.7)	2.81 (2.11-3.72)	2.56 (1.90-3.44)
Unknown	434 (52.6)	2.23 (1.72-2.89)	1.52 (1.16-2.00)
Treatment groups
Chemo alone	153 (18.5)	1.00 (reference)
Chemoradiation	61 (7.4)	0.98 (0.72-1.34)
Surgery	114 (13.8)	0.44 (0.34-0.59)
None	497 (60.2)	1.50 (1.24-1.81)
Surgery groups
Surgery Alone	69 (8.4)	1.00 (reference)
Adjuvant chemo	20 (2.4)	1.44 (0.82-2.55)
Adjuvant chemoradiation	21 (2.5)	1.02 (0.56-1.85)
Adjuvant radiation	4 (0.5)	1.53 (0.55-4.26)
No surgery	711 (86.2)	3.19 (2.35-4.33)
Surgery1
No	711 (86.2)	1.00 (reference )	1.00 (reference )
Yes	114 (13.7)	0.34 (0.27-0.43)	0.42 (0.32-0.54)
Chemo1
No	570 (69.1)	1.00 (reference )	1.00 (reference )
Yes	255 (30.9)	0.73 (0.62-0.85)	0.70 (0.59-0.83)
Radiation1
No	707 (85.7)	1.00 (reference )
Yes	118 (14.3)	0.74 (0.60-0.90)

¹Included in step-wise model. On univariate analysis, older age, black race, lower socioeconomic status, undifferentiated tumors, and T4 tumors were significantly associated with poorer survival. Upon stepwise analysis, older age (> 80 year), advanced disease stage, poorly differentiated or undifferentiated tumors, and lymph node involvement were independent predictors of poorer survival in all treatment groups. There was a significant improvement in survival associated with surgical resection and receipt of chemotherapy. chemo: Chemotherapy; AJCC: American Joint Committee on Cancer.