title: Identification of prognostic factors and the impact of palliative resection on survival of patients with stage IV hepatolithiasis-associated intrahepatic cholangiocarcinoma.
abstract: BACKGROUND
  Hepatolithiasis-associated intrahepatic cholangiocarcinoma (IHHCC) has a poor prognosis, because of lower curative resection rate when diagnosed in the advanced stage. There has been insufficient data regarding prognostic factors and the impact of palliative resection on its outcome.
  
  
  METHODS
  A retrospective analysis of 78 eligible patients with stage IV IHHCC was performed. The potential prognostic factors were assessed by univariate and multivariate analyses. Patients were divided into groups A (margin positive) and B (nonresection) based on surgical methods. Demographic and operative data were compared.
  
  
  RESULTS
  Of 78 surgeries, R1 was achieved in 11, R2 in 21 and nonresection in 46 patients. Median overall survival (OS) of the entire cohort was 10.5 months. Surgery (P < 0.01), tumor differentiation (P = 0.03), AJCC stage (P < 0.01), and serum CEA levels (P < 0.01) were independent prognostic factors. Significant differences were achieved in OS (P < 0.01), operation time (P < 0.01), estimated blood loss (P < 0.01), and postoperative complications (P = 0.02) between groups A and B.
  
  
  CONCLUSIONS
  For patients with stage IV IHHCC, palliative resection is a rational and effective treatment. Normal serum CEA levels, higher tumor differentiation, and stage IVa predict good prognosis in stage IV IHHCC.
authors: Department of Hepatobiliary Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China.
authors: Guo-Wei
authors: GW
authors: Zhang
authors: Jian-Hua
authors: JH
authors: Lin
authors: Jian-Ping
authors: JP
authors: Qian
authors: Jie
authors: J
authors: Zhou
mesh_terms: D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms; D001653:Bile Ducts, Intrahepatic; D002454:Cell Differentiation; D017024:Chemotherapy, Adjuvant; D018281:Cholangiocarcinoma / Q000209:etiology / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D002769:Cholelithiasis / Q000150:complications*; D019583:Dose Fractionation, Radiation; D005260:Female; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000209:etiology / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010166:Palliative Care / Q000379:methods*; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D020266:Radiotherapy, Conformal; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: hepatolithiasis-associated intrahepatic cholangiocarcinoma (IHHCC); palliative surgery; prognostic factors