Brief Article
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World J Gastrointest Surg. Jun 27, 2013; 5(6): 178-186
Published online Jun 27, 2013. doi: 10.4240/wjgs.v5.i6.178
Impact of medical and surgical intervention on survival in patients with cholangiocarcinoma
Amanda K Arrington, Rebecca A Nelson, Ann Falor, Carrie Luu, Rebecca L Wiatrek, Marwan Fakih, Gagandeep Singh, Joseph Kim
Amanda K Arrington, Rebecca L Wiatrek, Gagandeep Singh, Joseph Kim, Division of Surgical Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, United States
Rebecca A Nelson, Department of Biostatistics, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, United States
Ann Falor, Carrie Luu, Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA 90509, United States
Marwan Fakih, Department of Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, United States
Author contributions: Arrington AK, Nelson RA, Wiatrek RL and Kim J designed and performed the research; Nelson RA contributed new analytic tools; Arrington AK, Nelson RA, Kim J analyzed data; Arrington AK, Nelson RA, Falor A, Luu C, Wiatrek RL, Fakih M, Singh G and Kim J wrote the paper.
Correspondence to: Joseph Kim, MD, Division of Surgical Oncology, City of Hope Comprehensive Cancer Center, 1500 East Duarte Road, Duarte, CA 91010, United States. jokim@coh.org
Telephone: +1-626-4717100 Fax: +1-626-3018865
Received: February 25, 2013
Revised: April 16, 2013
Accepted: May 8, 2013
Published online: June 27, 2013
Processing time: 119 Days and 3.9 Hours
Abstract

AIM: To examine surgical and medical outcomes for patients with cholangiocarcinoma using a population-based cancer registry.

METHODS: Using the California Cancer Registry’s Cancer Surveillance Program, patients with intrahepatic cholangiocarcinoma treated in Los Angeles County from 1988 to 2006 were identified and evaluated for clinical and pathologic factors and therapies received (surgery, radiation, and chemotherapy). The surgical cohort was further categorized into three treatment groups: patients who received adjuvant chemotherapy, adjuvant chemoradiation, or underwent surgery alone (no chemotherapy or radiation administered). Survival was assessed by Kaplan-Meier method; and Cox proportional hazard modeling was used in multivariate analysis.

RESULTS: Of 825 patients, 60.2% received no treatment. Of the remaining 328 patients, 18.5% chemotherapy only, 7.4% chemoradiation, and 13.8% underwent surgery. More male patients underwent surgical resection (P = 0.004). Surgical patients were younger than the patients receiving chemotherapy or chemoradiation (P < 0.001). Of the surgical cohort (n = 114), 60.5% underwent surgery alone while 39.5% underwent surgery plus adjuvant therapy (chemotherapy, n = 20; chemoradiation, n = 21) (P < 0.001). Median survival for all patients in the study was 6.6 mo. Median survival was highest for patients who underwent surgery (23 mo), whereas both chemotherapy (9 mo) and chemoradiation (8 mo) alone were each less effective (P < 0.001). By multivariate analysis, extent of disease, receipt of surgery, and administration of chemotherapy (with/without surgery) were independent predictors of overall survival.

CONCLUSION: This study demonstrates that surgery is a critical treatment modality. Multimodality treatment has yet to be standardized, but play a role in optimal therapy for cholangiocarcinoma.

Keywords: Cholangiocarcinoma; Chemotherapy; Surgery; Survival; Therapies

Core tip: Cholangiocarcinoma is an aggressive biliary tract cancer with few treatment options. Surgical resection has been the only available curative-intent treatment in early disease. This study demonstrates that multimodality therapy may provide the best improvement in survival.