title: Impact of medical and surgical intervention on survival in patients with cholangiocarcinoma.
abstract: OBJECTIVE
  To examine surgical and medical outcomes for patients with cholangiocarcinoma using a population-based cancer registry.
  
  
  METHODS
  Using the California Cancer Registry's Cancer Surveillance Program, patients with intrahepatic cholangiocarcinoma treated in Los Angeles County from 1988 to 2006 were identified and evaluated for clinical and pathologic factors and therapies received (surgery, radiation, and chemotherapy). The surgical cohort was further categorized into three treatment groups: patients who received adjuvant chemotherapy, adjuvant chemoradiation, or underwent surgery alone (no chemotherapy or radiation administered). Survival was assessed by Kaplan-Meier method; and Cox proportional hazard modeling was used in multivariate analysis.
  
  
  RESULTS
  Of 825 patients, 60.2% received no treatment. Of the remaining 328 patients, 18.5% chemotherapy only, 7.4% chemoradiation, and 13.8% underwent surgery. More male patients underwent surgical resection (P = 0.004). Surgical patients were younger than the patients receiving chemotherapy or chemoradiation (P < 0.001). Of the surgical cohort (n = 114), 60.5% underwent surgery alone while 39.5% underwent surgery plus adjuvant therapy (chemotherapy, n = 20; chemoradiation, n = 21) (P < 0.001). Median survival for all patients in the study was 6.6 mo. Median survival was highest for patients who underwent surgery (23 mo), whereas both chemotherapy (9 mo) and chemoradiation (8 mo) alone were each less effective (P < 0.001). By multivariate analysis, extent of disease, receipt of surgery, and administration of chemotherapy (with/without surgery) were independent predictors of overall survival.
  
  
  CONCLUSIONS
  This study demonstrates that surgery is a critical treatment modality. Multimodality treatment has yet to be standardized, but play a role in optimal therapy for cholangiocarcinoma.
authors: Amanda K Arrington, Rebecca L Wiatrek, Gagandeep Singh, Joseph Kim, Division of Surgical Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, United States.
authors: Amanda K
authors: AK
authors: Arrington
authors: Rebecca A
authors: RA
authors: Nelson
authors: Ann
authors: A
authors: Falor
authors: Carrie
authors: C
authors: Luu
authors: Rebecca L
authors: RL
authors: Wiatrek
authors: Marwan
authors: M
authors: Fakih
authors: Gagandeep
authors: G
authors: Singh
authors: Joseph
authors: J
authors: Kim
keywords: Chemotherapy; Cholangiocarcinoma; Surgery; Survival; Therapies
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