title: The clinical presentation and prognostic factors for intrahepatic and extrahepatic cholangiocarcinoma in a tertiary care centre.
abstract: BACKGROUND
  The incidence of cholangiocarcinoma is rising. Accurate predictors of survival at diagnosis are not well defined.
  
  
  OBJECTIVE
  To clarify the clinical presentation and prognostic factors of intrahepatic cholangiocarcinoma and extrahepatic cholangiocarcinoma in a contemporary cohort of patients.
  
  
  METHODS
  Records for consecutive patients at the University of Michigan hospital diagnosed with cholangiocarcinoma between January 2003 and April 2008 were reviewed.
  
  
  RESULTS
  In all, 136 patients had cholangiocarcinoma (79 intra- and 57 extrahepatic cholangiocarcinoma). Median survival was 27.3 months-25.8 months for intrahepatic cholangiocarcinoma and 30.3 months for extrahepatic cholangiocarcinoma. Independent predictors of mortality at presentation on multivariate analysis were elevated bilirubin level (HR 1.04, 95%CI 1.01-1.07), CA 19-9 levels >100 U/mL (HR 1.90, 95%CI 1.17-3.08) and stage of disease (HR 1.51, 95%CI 1.16-1.96). After adjusting for baseline prognostic factors, surgical therapy was associated with improved survival (HR 0.48; 95% CI 0.26-0.88). There were no significant differences regarding clinical presentation, disease stage (P = 0.98), and survival (P = 0.51) between intra- and extrahepatic cholangiocarcinoma.
  
  
  CONCLUSIONS
  Survival for cholangiocarcinoma remains poor with no significant difference in outcomes between intra- and extrahepatic cholangiocarcinoma. Stage of disease, bilirubin level and CA 19-9 level are important prognostic factors at presentation. Surgical therapy provides similar efficacy for both tumours when adjusted for other prognostic variables.
authors.affiliation: Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
authors.forename: A G
authors.initials: AG
authors.lastname: Singal
authors.forename: M O
authors.initials: MO
authors.lastname: Rakoski
authors.forename: R
authors.initials: R
authors.lastname: Salgia
authors.forename: S
authors.initials: S
authors.lastname: Pelletier
authors.forename: T H
authors.initials: TH
authors.lastname: Welling
authors.forename: R J
authors.initials: RJ
authors.lastname: Fontana
authors.forename: A S
authors.initials: AS
authors.lastname: Lok
authors.forename: J A
authors.initials: JA
authors.lastname: Marrero
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D017734:Bile Ducts, Extrahepatic / Q000473:pathology; D001653:Bile Ducts, Intrahepatic / Q000473:pathology; D001663:Bilirubin; D018281:Cholangiocarcinoma / Q000175:diagnosis / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D001663:Bilirubin