Published online Feb 28, 2016. doi: 10.3748/wjg.v22.i8.2601
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
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.
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.