title: Comorbidity negatively influences prognosis in patients with extrahepatic cholangiocarcinoma.
abstract: OBJECTIVE
  To study the outcome and prognostic factors in a series of patients with extrahepatic cholangiocarcinoma and determine the impact of comorbidity on survival.
  
  
  METHODS
  A retrospective analysis of 68 patients with extrahepatic cholangiocarcinoma (perihilar, n=37; distal, n=31) seen at a single tertiary-care institution during the period 1999-2003 was performed. Data on presentation, management, and outcome were assessed by chart review. Pathologic confirmation was obtained in 37 cases (54.4%). Comorbidity was evaluated by using the Charlson comorbidity index (CCI).
  
  
  RESULTS
  Mean age at diagnosis was 73.4+/-11.5 years. Jaundice was the most common symptom presented (86.8%). Median CCI score was 1 (range, 0 to 4). Nineteen patients (27.9%) underwent tumor resection. Palliative biliary drainage was performed in 39 patients (57.4%), and 6 patients (8.8%) received only best supportive care. Tumor-free margin status (R0) was achieved in 15 cases (78.9% of resection group). Baseline serum carbohydrate antigen 19-9 (CA 19-9) level was revealed to be an independent predictor of surgical treatment (P=0.026). Overall median survival was 3.1+/-0.9 mo, with 1- and 2-year survival rates of 21% and 7%, respectively. In the univariate analysis, tumor resection, CCI score, and serum CA 19-9 levels correlated significantly with outcome. In the multivariate analysis, only resection (HR 0.10; 95% CI, 0.02-0.51, P=0.005) and a CCI score>or=2 (HR 3.36; 95% CI, 1.0-10.9, P=0.045) were found to independently predict survival.
  
  
  CONCLUSIONS
  Tumor resection and comorbidity emerged as significant prognostic variables in extrahepatic cholangiocarcinoma. Comorbidity evaluation instruments should be applied in the clinical management of such patients.
authors.affiliation: Department of Internal Medicine, University Hospital 12 de Octubre, Avenue Córdoba, s/n, Universidad Complutense, Madrid 28041, Spain. mario_fdezruiz@yahoo.es
authors.forename: Mario
authors.initials: M
authors.lastname: Fernández-Ruiz
authors.forename: Juan-Manuel
authors.initials: JM
authors.lastname: Guerra-Vales
authors.forename: Francisco
authors.initials: F
authors.lastname: Colina-Ruizdelgado
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery; D017734:Bile Ducts, Extrahepatic / Q000473:pathology* / Q000601:surgery; D018281:Cholangiocarcinoma / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate