Retrospective Cohort Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 28, 2016; 22(8): 2601-2610
Published online Feb 28, 2016. doi: 10.3748/wjg.v22.i8.2601
Prognostic factors and long-term outcomes of hilar cholangiocarcinoma: A single-institution experience in China
Hai-Jie Hu, Hui Mao, Anuj Shrestha, Yong-Qiong Tan, Wen-Jie Ma, Qin Yang, Jun-Ke Wang, Nan-Sheng Cheng, Fu-Yu Li
Hai-Jie Hu, Anuj Shrestha, Yong-Qiong Tan, Wen-Jie Ma, Qin Yang, Jun-Ke Wang, Nan-Sheng Cheng, Fu-Yu Li, Department of Biliary Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
Hui Mao, Department of Respiratory Medicine, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
Anuj Shrestha, Department of General Surgery, Gandaki Medical College, Pokhara 33700, Nepal
Author contributions: Hu HJ contributed to the data acquisition and analysis and drafted the manuscript; Ma WJ, Yang Q, and Wang JK contributed to data acquisition and analysis of the manuscript; Shrestha A helped draft and revise the manuscript; Cheng NS and Tan YQ were involved in the revision of the manuscript; Li FY and Mao H contributed to the study design and revision of the manuscript; all authors read and approved the final manuscript.
Supported by The National Nature Science of China, No. 3080111 and No. 30972923; and Science and Technology Support Project of Sichuan Province, No. 2014SZ0002-10.
Institutional review board statement: The study was reviewed and supported by the West China Hospital of Sichuan University Institutional Review Board.
Informed consent statement: All involved patients gave their informed consent statement prior to the study inclusion.
Conflict-of-interest statement: We declare that we have no conflicts of interest.
Data sharing statement: No additional unpublished data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Fu-Yu Li, MD, PhD, Department of Biliary Surgery, West China Hospital of Sichuan University, 37 Guoxue Xiang, Wuhou District, Chengdu 610041, Sichuan Province, China. lfy_74@hotmail.com
Telephone: + 86-28-85422465 Fax: +86-28-85422465
Received: October 13, 2015
Peer-review started: October 14, 2015
First decision: November 5, 2015
Revised: November 18, 2015
Accepted: December 8, 2015
Article in press: December 8, 2015
Published online: February 28, 2016
Processing time: 135 Days and 5.5 Hours
Abstract

AIM: To evaluate the prognostic factors of hilar cholangiocarcinoma in a large series of patients in a single institution.

METHODS: Eight hundred and fourteen patients with a diagnosis of hilar cholangiocarcinoma that were evaluated and treated between 1990 and 2014, of which 381 patients underwent curative surgery, were included in this study. Potential factors associated with overall survival (OS) and disease-free survival (DFS) were evaluated by univariate and multivariate analyses.

RESULTS: Curative surgery provided the best long-term survival with a median OS of 26.3 mo. The median DFS was 18.1 mo. Multivariate analysis showed that patients with tumor size > 3 cm [hazard ratio (HR) = 1.482, 95%CI: 1.127-1.949; P = 0.005], positive nodal disease (HR = 1.701, 95%CI: 1.346-2.149; P < 0.001), poor differentiation (HR = 2.535, 95%CI: 1.839-3.493; P < 0.001), vascular invasion (HR = 1.542, 95%CI: 1.082-2.197; P = 0.017), and positive margins (HR = 1.798, 95%CI: 1.314-2.461; P < 0.001) had poor OS outcome. The independent factors for DFS were positive nodal disease (HR = 3.383, 95%CI: 2.633-4.348; P < 0.001), poor differentiation (HR = 2.774, 95%CI: 2.012-3.823; P < 0.001), vascular invasion (HR = 2.136, 95%CI: 1.658-3.236; P < 0.001), and positive margins (HR = 1.835, 95%CI: 1.256-2.679; P < 0.001). Multiple logistic regression analysis showed that caudate lobectomy [odds ratio (OR) = 9.771, 95%CI: 4.672-20.433; P < 0.001], tumor diameter (OR = 3.772, 95%CI: 1.914-7.434; P < 0.001), surgical procedures (OR = 10.236, 95%CI: 4.738-22.116; P < 0.001), American Joint Committee On Cancer T stage (OR = 2.010, 95%CI: 1.043-3.870; P = 0.037), and vascular invasion (OR = 2.278, 95%CI: 0.997-5.207; P = 0.051) were independently associated with tumor-free margin, and surgical procedures could indirectly affect survival outcome by influencing the tumor resection margin.

CONCLUSION: Tumor margin, tumor differentiation, vascular invasion, and lymph node status were independent factors for OS and DFS. Surgical procedures can indirectly affect survival outcome by influencing the tumor resection margin.

Keywords: Hilar cholangiocarcinoma; Prognosis; Surgical outcome; Survival; Tumor-free margin

Core tip: Hilar cholangiocarcinoma remains among the most difficult management problems faced by surgeons. Although curative surgery prolongs the survival time of patients diagnosed with hilar cholangiocarcinoma, outcomes from studies may be contradictory or biased due to differences in study methods and small patient numbers. Furthermore, some large, multi-center reports may induce biases due to the heterogeneity of clinical methods and surgical strategies. Thus, we retrospectively analyzed the prognostic factors of hilar cholangiocarcinoma and factors associated with tumor-free margin in a large sample of hilar cholangiocarcinoma cases from a single institution.