title: C-reactive protein is a prognostic indicator in patients with perihilar cholangiocarcinoma.
abstract: OBJECTIVE
  To evaluate prognostic indicators for the outcome of patients with perihilar extrahepatic cholangiocarcinoma in an unselected cohort.
  
  
  METHODS
  We retrospectively analyzed 98 patients with perihilar cholangiocarcinoma. Twenty-three patients (23.5%) underwent tumor resection. Patients with non-resectable tumors underwent either transpapillary or percutaneous transhepatic biliary drainage. Additionally, 32 patients (32.7%) received photodynamic therapy (PDT) and 18 patients (18.4%) systemic chemotherapy. Predefined variables at the time of diagnosis and characteristics considering the mode of treatment were entered into a Cox's proportional hazards model. Included in the analysis were age, tumor stage following the modified Bismuth-Corlette classification, bilirubin, prothrombin time (PT), C-reactive protein (CRP), carbohydrate antigen 19-9 (CA19-9), history of weight loss, surgical resection, chemotherapy and PDT.
  
  
  RESULTS
  The Kaplan-Meier estimate of overall median survival was 10.5 (95%CI: 8.4-12.6) mo. In the univariate analysis, low Bismuth stage, low CRP and surgical resection correlated significantly with better survival. In the multivariate analysis, only CRP (P = 0.005) and surgical resection (P = 0.029) were found to be independently predictive of survival in the cohort. Receiver operating characteristic (ROC) analysis identified a CRP level of 11.75 mg/L as the value associated with the highest sensitivity and specificity predicting a survival > 5 mo. Applying Kaplan-Meier analysis, patients with a CRP < 12 mg/L at the time of diagnosis had a significantly longer median survival than patients with higher values (16.2 vs 7.6 mo; P = 0.009).
  
  
  CONCLUSIONS
  This retrospective analysis identified CRP level at the time of diagnosis as a novel indicator for the prognosis of patients with perihilar cholangiocarcinoma. It should be evaluated in future prospective trials on this entity.
authors.affiliation: Department of Internal Medicine I, University Hospital, Sigmund-Freud-Strasse 25, D-53105 Bonn, Germany. thomas.gerhardt@ukb.uni-bonn.de
authors.forename: Thomas
authors.initials: T
authors.lastname: Gerhardt
authors.forename: Sabine
authors.initials: S
authors.lastname: Milz
authors.forename: Michael
authors.initials: M
authors.lastname: Schepke
authors.forename: Georg
authors.initials: G
authors.lastname: Feldmann
authors.forename: Martin
authors.initials: M
authors.lastname: Wolff
authors.forename: Tilman
authors.initials: T
authors.lastname: Sauerbruch
authors.forename: Franz Ludwig
authors.initials: FL
authors.lastname: Dumoulin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000097:blood* / Q000175:diagnosis / Q000601:surgery; D001653:Bile Ducts, Intrahepatic; D014408:Biomarkers, Tumor / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis*; D018281:Cholangiocarcinoma / Q000097:blood* / Q000175:diagnosis / Q000601:surgery; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor; D002097:C-Reactive Protein