title: Long-term outcome and prognostic factors of patients with hilar cholangiocarcinoma.
abstract: 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.
authors: Department of Internal Medicine II, Technical University of Munich, Munich, Germany.
authors: Andreas
authors: A
authors: Weber
authors: Sonja
authors: S
authors: Landrock
authors: Jochen
authors: J
authors: Schneider
authors: Manfred
authors: M
authors: Stangl
authors: Bruno
authors: B
authors: Neu
authors: Peter
authors: P
authors: Born
authors: Meinhard
authors: M
authors: Classen
authors: Thomas
authors: T
authors: Rösch
authors: Roland-M
authors: RM
authors: Schmid
authors: Christian
authors: C
authors: Prinz
mesh_terms: 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
chemical_list: D001663:Bilirubin