Long-term outcomes and prognostic factors of surgical resection of hilar cholangiocarcinoma

Objective To investigate the long-term outcomes and prognostic factors of surgical resection of hilar cholangiocarcinoma. Methods The retrospective case-control study was adopted. The clinicopathological data of 129 patients with hilar cholangiocarcinoma who underwent surgery at the First Affiliated Hospital of Sun Yat-sen University between January 2007 and August 2014 were collected. The follow-up of outpatient examination and telephone interview was performed to observe the survival of patients, tumor recurrence and metastasis up to October 2015. (1) Long-term outcomes (1-, 3-, 5-year survival rates and survival time) were observed. (2) Prognostic factors were collected, including gender, age, preoperative CA19-9, tumor diameter, curative degree of tumor (R0 resection or R1 resection), vascular resection and reconstruction, modified T stage, lymph node metastasis, TNM stage and tumor differentiation. (3) The stratified analyses were used for the independent prognostic factors. The survival curve was drawn by Kaplan-Meier method, and the survival rate was analyzed using the Log-rank test. The univariate analysis and multivariate analysis were respectively done using the chi-square test and COX regression model. Results (1) Of 129 patients, 4 patients were dead in the perioperative period, 112 were followed up for a median time of 19 months (range, 1-98 months). During the follow-up, 75 patients were dead. The overall median survival time and 1-, 3-, 5-year survival rates of the 129 patients were 23 months, 71.1%, 31.4% and 14.6%, respectively. (2) The results of univariate analysis showed that curative degree of tumor, modified T stage, lymph node metastasis, TNM stage and tumor differentiation were the related factors affecting the prognosis of patients undergoing surgical resection of hilar cholangiocarcinoma (χ2=5.566, 5.450, 4.558, 4.033, 6.093, P<0.05). The results of multivariate analysis showed that R1 resection, stage Ⅲ-Ⅳ and low-differentiated tumor were the independent risk factors affecting the poor prognosis of patients undergoing surgical resection of hilar cholangiocarcinoma (HR=2.328, 1.691, 1.750, 95% confidence interval: 1.224-4.427, 1.035-2.762, 1.205-2.542, P<0.05). (3) The median survival time and 1-, 3-, 5-year survival rates were 24 months, 75.5%, 36.0% , 15.8% in 110 patients with R0 resection, the median survival time and 1-, 3-year survival rates were 12 months, 47.1% and 7.1% and the 5-year survival rate missed in the 19 patients with R1 resection, with a statistically significant difference (χ2=5.566, P<0.05). The median survival time and 1-, 3-, 5-year survival rates were 30 months, 75.0%, 42.5%, 20.1% in 55 patients with stageⅠ-Ⅱ and 18 months, 68.1%, 22.2%, 7.0% in 74 patients with stage Ⅲ-Ⅳ, respectively, showing a statistically significant difference (χ2=4.033, P<0.05). The median survival time and 1-, 3-, 5-year survival rates were 30 months, 82.4%, 49.5%, 49.5% in 19 patients with high-differentiated tumor, 24 months, 69.6%, 30.4%, 11.8% in 62 patients with moderate-differentiated tumor, 18 months, 63.5%, 24.2%, 0.0 in 33 patients with low-differentiated tumor, respectively, with a statistically significant difference (χ2=6.093, P<0.05). Conclusions Long-term outcomes of surgical resection of hilar cholangiocarcinoma are unsatisfactory. Moreover, R1 resection, stage Ⅲ-Ⅳ and low-differentiated tumor are the independent risk factors affecting the poor prognosis of patients undergoing surgical resection of hilar cholangiocarcinoma. Key words: Biliary tract neoplasms, hilar; Surgical resection; Prognostic factors