title: Predictive factors for prognosis of hilar cholangiocarcinoma: postresection radiotherapy improves survival.
abstract: OBJECTIVE
  Several studies have analyzed the determinants of long-term survival in hilar cholangiocarcinoma (HCCA) patients, but the majority of these have not speculated adjuvant therapy on prognosis. We conduct this study to identify potential predictive factors for prognosis of HCCA focusing on aspects dealing with adjuvant therapy.
  
  
  METHODS
  Data from 75 consecutive HCCA patients undergoing surgical resection with curative intent were recorded prospectively. The survivals of patients were comparable with respect to different factors followed by a univariate and multivariate analysis.
  
  
  RESULTS
  Actual 1-year, 3-year, and 5-year survival rates were 84.0, 44.4 and 12.0%, respectively. By Cox proportional hazards survival analysis, the most powerful predictors of outcome was resection type (Hazard Ratio [HR] 17.4, 95% confidence interval [CI] 16.8-17.8), followed by adjuvant radiotherapy (RT) (HR 4.3, 95% CI 3.6-4.9), regional lymph nodes involvement (HR 2.1, 95% CI 1.7-2.6), and preoperative maximum serum total bilirubin level (HR 2.0, 95% CI 1.5-2.5).
  
  
  CONCLUSIONS
  Our study showed overall a highly significant benefit in survival in favor of RT, and the difference was especially significant after R1/R2 resection and in patients with Bismuth III/IV type tumors. Postresection chemotherapy (CTx) did not show any clinical benefits. R0 resection still significantly improves survival. Lower total serum bilirubin level, no regional lymph nodes involvement conferred survival advantage.
authors.affiliation: Department of Biliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Changhai Road 225, Shanghai 200438, China.
authors.forename: Q
authors.initials: Q
authors.lastname: Cheng
authors.forename: X
authors.initials: X
authors.lastname: Luo
authors.forename: B
authors.initials: B
authors.lastname: Zhang
authors.forename: X
authors.initials: X
authors.lastname: Jiang
authors.forename: B
authors.initials: B
authors.lastname: Yi
authors.forename: M
authors.initials: M
authors.lastname: Wu
mesh_terms: D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery; D001653:Bile Ducts, Intrahepatic; D002681:China / Q000453:epidemiology; D018281:Cholangiocarcinoma / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors