title: Novel prognostic scoring system after surgery for Klatskin tumor.
abstract: Klatskin tumor is a rare hepatobiliary malignancy whose outcome and prognostic factors are not clearly documented. Between April 1998 and January 2007, 96 patients with hilar cholangiocarcinoma underwent resection. Data were collected prospectively. Thirty-one variables were evaluated  for prognostic significance. There were 40 trisectionectomies, 40 hemihepatectomies, five central hepatectomies, and 11 biliary hilar resections. Thirty-seven (n = 37) patients required vascular reconstruction. There were 68 R0, 26 R1, and two R2 resections. Age (P = 0.048), pT status  (P = 0.046), R class (P = 0.034), and adjuvant chemoradiation (P = 0.045) showed predictive significance by multivariate Cox proportional hazard regression analysis. A point scoring system was determined as follows: age younger than 62 years:age 62 years or older = 1:2  points; pT1:pT2 to 4 = 1:2 points; R0:R1/2 = 1:2 points; and chemoradiation yes:no = 1:2 points. The only model that reached statistical significance (P = 0.0332) described the following three groups: score 6 or less; score = 7; and score = 8. Median survival for score 6 or less, score  = 7, and score = 8 was 26.5, 12, and 2.2 months, respectively (P = 0.032). The corresponding 1- and 3-year survival rates were 73 to 56 per cent, 52 to 38 per cent, and 17 to 0 per cent, respectively. We propose a scoring system predictive of long-term surgical outcome that could potentially  improve patient selection for further postoperative oncologic treatment for Klatskin tumors.
authors: Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany.
authors: Gernot M
authors: GM
authors: Kaiser
authors: Andreas
authors: A
authors: Paul
authors: George
authors: G
authors: Sgourakis
authors: Ernesto P
authors: EP
authors: Molmenti
authors: Alexander
authors: A
authors: Dechêne
authors: Tanja
authors: T
authors: Trarbach
authors: Martin
authors: M
authors: Stuschke
authors: Hideo A
authors: HA
authors: Baba
authors: Guido
authors: G
authors: Gerken
authors: Georgios C
authors: GC
authors: Sotiropoulos
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D059186:Chemoradiotherapy, Adjuvant; D003661:Decision Support Techniques; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods; D006500:Hepatic Duct, Common / Q000601:surgery*; D006801:Humans; D018285:Klatskin Tumor / Q000175:diagnosis / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D018579:Patient Selection; D011379:Prognosis; D011446:Prospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome