Long-term outcome and prognostic factors of patients with hilar cholangiocarcinoma.
OBJECTIVE
To evaluate the long-term outcome and prognostic factors of patients with hilar cholangiocarinoma.


METHODS
Ninety-six consecutive patients underwent treatment for malignant hilar bile duct tumors during 1995-2005. Of the 96 patients, 20 were initially treated with surgery (n = 2 R0 / n = 18 R1). In non-operated patients, data analysis was performed retrospectively.


RESULTS
Among the 96 patients, 76 were treated with endoscopic transpapillary (ERC, n = 45) and/or percutaneous transhepatic biliary drainage (PTBD, n = 31). The mean survival time of these 76 patients undergoing palliative endoscopic and/or percutaneous drainage was 359 +/- 296 d. The mean survival time of patients with initial bilirubin levels > 10 mg/dL was significantly lower (P < 0.001) than patients with bilirubin levels < 10 mg/dL. The mean survival time of patients with Bismuth stage II (n = 8), III (n = 28) and IV (n = 40) was 496 +/- 300 d, 441 +/- 385 d and 274 +/- 218 d, respectively. Thus, patients with advanced Bismuth stage showed a reduced mean survival time, but the difference was not significant. The type of biliary drainage had no significant beneficial effect on the mean survival time (ERC vs PTBD, P = 0.806).


CONCLUSIONS
Initial bilirubin level is a significant prognostic factor for survival of patients. In contrast, age, tumor stage according to the Bismuth-Corlette classification, and types of intervention are not significant prognostic parameters for survival. Palliative treatment with endoscopic or percutaneous biliary drainage is still suboptimal, new diagnostic and therapeutic tools need to be evaluated.
Weber
Andreas
A
Department of Internal Medicine II, Technical University of Munich, Munich, Germany.
Landrock
Sonja
S
Schneider
Jochen
J
Stangl
Manfred
M
Neu
Bruno
B
Born
Peter
P
Classen
Meinhard
M
Rösch
Thomas
T
Schmid
Roland-M
RM
Prinz
Christian
C
D000368:Aged; D001650:Bile Duct Neoplasms / Q000097:blood* / Q000175:diagnosis* / Q000628:therapy; D001653:Bile Ducts, Intrahepatic; D001663:Bilirubin / Q000097:blood*; D018281:Cholangiocarcinoma / Q000097:blood* / Q000175:diagnosis* / Q000628:therapy; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
D001663:Bilirubin