title: Prognostic factors in resectable cholangiocarcinoma patients: Carcinoembryonic antigen, lymph node, surgical margin and chemotherapy.
abstract: OBJECTIVE
  To evaluate outcomes in resectable cholangiocarcinoma patients and to determine prognostic factors.
  
  
  METHODS
  A retrospective study was conducted among newly-diagnosed cholangiocarcinoma patients from January 2009 to December 2011 who underwent curative resection in Srinakarind Hospital (a 1000-bed university hospital). Two hundred and sixty-three cholangiocarcinoma patients with good performance were enrolled. These patients had pathological reports with clear margins or microscopic margins. Prognostic factors which included clinical factors, serum liver function test as well as serum tumor makers at presentation, tumor data, and receiving adjuvant chemotherapy were determined by uni- and multivariate analysis.
  
  
  RESULTS
  The median overall survival time was 17 mo (95%CI: 13.2-20.7); and 1-, 2-, and 3- year survival rates were 65.5%, 45.2% and 35.4%. Serum albumin levels, serum carcinoembryonic antigen (CEA) levels, staging classifications by American Joint Committee on cancer, pathological tumor staging, lymph node metastases, tumor grading, surgical margin status, and if adjuvant chemotherapy was administered, were shown to be significant prognostic factors of resectable cholangiocarcinoma by univariate analysis. Multivariate analysis, however, established that only abnormal serum CEA [hazard ratio (HR) 1.68; P = 0.027] and lymph node metastases (HR 2.27; P = 0.007) were significantly associated with a decrease in overall survival, while adjuvant chemotherapy (HR 0.71; P = 0.067) and surgical margin negative (HR 0.72; P = 0.094) tended to improve survival time.
  
  
  CONCLUSIONS
  Serum CEA and lymph node metastases which were associated with advanced stage tumors become strong negative prognostic factors in cholangiocarcinoma.
authors.affiliation: Kosin Wirasorn, Thundon Ngamprasertchai, Jarin Chindaprasirt, Aumkhae Sookprasert, Department of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand.
authors.forename: Kosin
authors.initials: K
authors.lastname: Wirasorn
authors.forename: Thundon
authors.initials: T
authors.lastname: Ngamprasertchai
authors.forename: Jarin
authors.initials: J
authors.lastname: Chindaprasirt
authors.forename: Aumkhae
authors.initials: A
authors.lastname: Sookprasert
authors.forename: Narong
authors.initials: N
authors.lastname: Khantikaew
authors.forename: Ake
authors.initials: A
authors.lastname: Pakkhem
authors.forename: Piti
authors.initials: P
authors.lastname: Ungarereevittaya
keywords: Adjuvant; Carcinoembryonic antigen; Chemotherapy; Cholangiocarcinoma; Hepatectomy; Lymph nodes; Neoplasm metastasis; Prognosis; Surgical margin status; Survival rate