title: Prognostic factors and long-term outcomes of hilar cholangiocarcinoma: A single-institution experience in China.
abstract: OBJECTIVE
  To evaluate the prognostic factors of hilar cholangiocarcinoma in a large series of patients in a single institution.
  
  
  METHODS
  Eight hundred and fourteen patients with a diagnosis of hilar cholangiocarcinoma that were evaluated and treated between 1990 and 2014, of which 381 patients underwent curative surgery, were included in this study. Potential factors associated with overall survival (OS) and disease-free survival (DFS) were evaluated by univariate and multivariate analyses.
  
  
  RESULTS
  Curative surgery provided the best long-term survival with a median OS of 26.3 mo. The median DFS was 18.1 mo. Multivariate analysis showed that patients with tumor size > 3 cm [hazard ratio (HR) = 1.482, 95%CI: 1.127-1.949; P = 0.005], positive nodal disease (HR = 1.701, 95%CI: 1.346-2.149; P < 0.001), poor differentiation (HR = 2.535, 95%CI: 1.839-3.493; P < 0.001), vascular invasion (HR = 1.542, 95%CI: 1.082-2.197; P = 0.017), and positive margins (HR = 1.798, 95%CI: 1.314-2.461; P < 0.001) had poor OS outcome. The independent factors for DFS were positive nodal disease (HR = 3.383, 95%CI: 2.633-4.348; P < 0.001), poor differentiation (HR = 2.774, 95%CI: 2.012-3.823; P < 0.001), vascular invasion (HR = 2.136, 95%CI: 1.658-3.236; P < 0.001), and positive margins (HR = 1.835, 95%CI: 1.256-2.679; P < 0.001). Multiple logistic regression analysis showed that caudate lobectomy [odds ratio (OR) = 9.771, 95%CI: 4.672-20.433; P < 0.001], tumor diameter (OR = 3.772, 95%CI: 1.914-7.434; P < 0.001), surgical procedures (OR = 10.236, 95%CI: 4.738-22.116; P < 0.001), American Joint Committee On Cancer T stage (OR = 2.010, 95%CI: 1.043-3.870; P = 0.037), and vascular invasion (OR = 2.278, 95%CI: 0.997-5.207; P = 0.051) were independently associated with tumor-free margin, and surgical procedures could indirectly affect survival outcome by influencing the tumor resection margin.
  
  
  CONCLUSIONS
  Tumor margin, tumor differentiation, vascular invasion, and lymph node status were independent factors for OS and DFS. Surgical procedures can indirectly affect survival outcome by influencing the tumor resection margin.
authors.affiliation: Hai-Jie Hu, Anuj Shrestha, Yong-Qiong Tan, Wen-Jie Ma, Qin Yang, Jun-Ke Wang, Nan-Sheng Cheng, Fu-Yu Li, Department of Biliary Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Hai-Jie
authors.initials: HJ
authors.lastname: Hu
authors.affiliation: Hai-Jie Hu, Anuj Shrestha, Yong-Qiong Tan, Wen-Jie Ma, Qin Yang, Jun-Ke Wang, Nan-Sheng Cheng, Fu-Yu Li, Department of Biliary Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Mao
authors.affiliation: Hai-Jie Hu, Anuj Shrestha, Yong-Qiong Tan, Wen-Jie Ma, Qin Yang, Jun-Ke Wang, Nan-Sheng Cheng, Fu-Yu Li, Department of Biliary Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Anuj
authors.initials: A
authors.lastname: Shrestha
authors.affiliation: Hai-Jie Hu, Anuj Shrestha, Yong-Qiong Tan, Wen-Jie Ma, Qin Yang, Jun-Ke Wang, Nan-Sheng Cheng, Fu-Yu Li, Department of Biliary Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Yong-Qiong
authors.initials: YQ
authors.lastname: Tan
authors.affiliation: Hai-Jie Hu, Anuj Shrestha, Yong-Qiong Tan, Wen-Jie Ma, Qin Yang, Jun-Ke Wang, Nan-Sheng Cheng, Fu-Yu Li, Department of Biliary Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Wen-Jie
authors.initials: WJ
authors.lastname: Ma
authors.affiliation: Hai-Jie Hu, Anuj Shrestha, Yong-Qiong Tan, Wen-Jie Ma, Qin Yang, Jun-Ke Wang, Nan-Sheng Cheng, Fu-Yu Li, Department of Biliary Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Qin
authors.initials: Q
authors.lastname: Yang
authors.affiliation: Hai-Jie Hu, Anuj Shrestha, Yong-Qiong Tan, Wen-Jie Ma, Qin Yang, Jun-Ke Wang, Nan-Sheng Cheng, Fu-Yu Li, Department of Biliary Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Jun-Ke
authors.initials: JK
authors.lastname: Wang
authors.affiliation: Hai-Jie Hu, Anuj Shrestha, Yong-Qiong Tan, Wen-Jie Ma, Qin Yang, Jun-Ke Wang, Nan-Sheng Cheng, Fu-Yu Li, Department of Biliary Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Nan-Sheng
authors.initials: NS
authors.lastname: Cheng
authors.affiliation: Hai-Jie Hu, Anuj Shrestha, Yong-Qiong Tan, Wen-Jie Ma, Qin Yang, Jun-Ke Wang, Nan-Sheng Cheng, Fu-Yu Li, Department of Biliary Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Fu-Yu
authors.initials: FY
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D001662:Biliary Tract Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D002454:Cell Differentiation; D016009:Chi-Square Distribution; D002681:China; D016208:Databases, Factual; D018572:Disease-Free Survival; D006498:Hepatectomy / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D018285:Klatskin Tumor / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D016015:Logistic Models; D008207:Lymphatic Metastasis; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D016017:Odds Ratio; D010166:Palliative Care; D018579:Patient Selection; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Hilar cholangiocarcinoma; Prognosis; Surgical outcome; Survival; Tumor-free margin