Retrospective analysis of prognostic factors after liver resection and transplantation for cholangiocellular carcinoma.
BACKGROUND
Cholangiocellular carcinoma is an uncommon primary liver cancer, which may be mixed with hepatocellular carcinoma. A retrospective analysis was undertaken to evaluate the results of surgical treatment and to identify prognostic factors.


METHODS
Between 1978 and 1996, 162 patients underwent surgery for cholangiocellular carcinoma: liver resection (n = 95), liver transplantation (n = 24) and exploratory laparotomy with and without drainage (n = 43). Univariate and multivariate analyses of prognostic factors were performed.


RESULTS
Overall survival was 47 per cent at 1 year, 28 per cent at 2 years and 13 per cent at 5 years. Survival rates for patients with resectable tumours were 64, 43 and 21 per cent respectively, and for those who underwent liver transplantation 21, 8 per cent and zero respectively. Univariate analysis showed that the following variables had an effect on survival: age, jaundice, liver resection, T, N and M stage in the tumour node metastasis classification, Union Internacional Contra la Cancrum (UICC) tumour stage, tumour-free margins, vascular infiltration, tumour number, tumour size and serum level of carcinoembryonic antigen. Multivariate analysis identified jaundice, N and M category, and UICC tumour stage as independent prognostic factors.


CONCLUSIONS
The data underscore the importance and prognostic value of the UICC tumour classification for cholangiocellular carcinoma. The prognosis of mixed tumours is no different. Liver resection remains the treatment of choice; transplantation offers no solution for otherwise unresectable tumours.
Weimann
A
A
Klinik für Abdominal- und Transplantationschirurgie, Medizinische Hochschule Hannover, Hannover, Germany.
Varnholt
H
H
Schlitt
H J
HJ
Lang
H
H
Flemming
P
P
Hustedt
C
C
Tusch
G
G
Raab
R
R
D000368:Aged; D001650:Bile Duct Neoplasms / Q000097:blood / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic / Q000601:surgery*; D002272:Carcinoembryonic Antigen / Q000097:blood; D018281:Cholangiocarcinoma / Q000097:blood / Q000601:surgery*; D006801:Humans; D008099:Liver / Q000601:surgery; D016031:Liver Transplantation / Q000379:methods*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000601:surgery; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome; D000509:alpha-Fetoproteins / Q000032:analysis
D002272:Carcinoembryonic Antigen; D000509:alpha-Fetoproteins