Clinical Research
Copyright ©2006 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Sep 14, 2006; 12(34): 5495-5500
Published online Sep 14, 2006. doi: 10.3748/wjg.v12.i34.5495
C-reactive protein is a prognostic indicator in patients with perihilar cholangiocarcinoma
Thomas Gerhardt, Sabine Milz, Michael Schepke, Georg Feldmann, Martin Wolff, Tilman Sauerbruch, Franz Ludwig Dumoulin
Thomas Gerhardt, Sabine Milz, Michael Schepke, Georg Feldmann, Tilman Sauerbruch, Franz Ludwig Dumoulin, Department of Internal Medicine I, University Hospital Bonn, Germany
Martin Wolff, Department of Surgery, University Hospital Bonn, Germany
Correspondence to: Dr. Thomas Gerhardt, Department of Internal Medicine I, University Hospital, Sigmund-Freud-Str. 25, D-53105 Bonn, Germany. thomas.gerhardt@ukb.uni-bonn.de
Telephone: +49-228-28715507 Fax: +49-228-28714323
Received: April 14, 2006
Revised: April 28, 2006
Accepted: May 25, 2006
Published online: September 14, 2006
Abstract

AIM: To evaluate prognostic indicators for the outcome of patients with perihilar extrahepatic cholangiocarcinoma in an unselected cohort.

METHODS: We retrospectively analyzed 98 patients with perihilar cholangiocarcinoma. Twenty-three patients (23.5%) underwent tumor resection. Patients with non-resectable tumors underwent either transpapillary or percutaneous transhepatic biliary drainage. Additionally, 32 patients (32.7%) received photodynamic therapy (PDT) and 18 patients (18.4%) systemic chemotherapy. Predefined variables at the time of diagnosis and characteristics considering the mode of treatment were entered into a Cox’s proportional hazards model. Included in the analysis were age, tumor stage following the modified Bismuth-Corlette classification, bilirubin, prothrombin time (PT), C-reactive protein (CRP), carbohydrate antigen 19-9 (CA19-9), history of weight loss, surgical resection, chemotherapy and PDT.

RESULTS: The Kaplan-Meier estimate of overall median survival was 10.5 (95%CI: 8.4-12.6) mo. In the univariate analysis, low Bismuth stage, low CRP and surgical resection correlated significantly with better survival. In the multivariate analysis, only CRP (P = 0.005) and surgical resection (P = 0.029) were found to be independently predictive of survival in the cohort. Receiver operating characteristic (ROC) analysis identified a CRP level of 11.75 mg/L as the value associated with the highest sensitivity and specificity predicting a survival > 5 mo. Applying Kaplan-Meier analysis, patients with a CRP < 12 mg/L at the time of diagnosis had a significantly longer median survival than patients with higher values (16.2 vs 7.6 mo; P = 0.009).

CONCLUSION: This retrospective analysis identified CRP level at the time of diagnosis as a novel indicator for the prognosis of patients with perihilar cholangiocarcinoma. It should be evaluated in future prospective trials on this entity.

Keywords: Perihilar cholangiocarcinoma, Prognostic factors, C-reactive protein, Resection, Outcome