Conditional probability of long-term survival after resection of hilar cholangiocarcinoma.
While traditional survival analyses focus on factors determined at the time of surgery, conditional survival (CS) estimates prognosis relative to time following treatment. We sought to compare actuarial and CS among patients undergoing curative intent surgery for hilar cholangiocarcinoma.



242 patients undergoing surgery between 2000 and 2014 were identified using a multi-institutional database. CS was calculated as the probability of surviving an additional 3 years, given that the patient had already survived "x" years from surgery.



Median patient age was 67 years (IQR: 57-73) and most patients were male (n = 140, 57.9%). Lymph node metastases were noted in 79 (32.6%) patients while an R0 margin was obtained in 66.1% (n = 160). Median OS was 22.3 months. Actuarial survival decreased over time from 46.3% at 2 years following surgery to 18.2% at 5 years; in contrast, the 3-year CS (CS3) increased with time (CS3 at 2 years was 39.3% versus 54.4% at 5 years). CS3 exceeded actuarial survival for high-risk patients with patients with perineural invasion demonstrating an actuarial survival of 15.4% at 5 years versus CS3 of 37.6% at 2 years following surgery (Δ = 22.2%).



CS provides a more accurate, dynamic estimate for survival, especially among high-risk patients.
Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA.
Stefan
S
Buettner
Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA.
Georgios A
GA
Margonis
Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA.
Yuhree
Y
Kim
Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA.
Faiz
F
Gani
Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA.
Cecilia G
CG
Ethun
Department of Surgery, Stanford University Medical Center, Stanford, CA, USA.
George
G
Poultsides
Department of Surgery, Stanford University Medical Center, Stanford, CA, USA.
Thuy
T
Tran
Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
Kamran
K
Idrees
Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
Chelsea A
CA
Isom
Department of Surgery, Washington University School of Medicine, St Louis, MO, USA.
Ryan C
RC
Fields
Department of Surgery, Washington University School of Medicine, St Louis, MO, USA.
Bradley
B
Krasnick
Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Sharon M
SM
Weber
Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Ahmed
A
Salem
Department of Surgery, University of Louisville, Louisville, KY, USA.
Robert C G
RC
Martin
Department of Surgery, University of Louisville, Louisville, KY, USA.
Charles R
CR
Scoggins
Department of Surgery, Wake Forest University, Winston-Salem, NC, USA.
Perry
P
Shen
Department of Surgery, Wake Forest University, Winston-Salem, NC, USA.
Harveshp D
HD
Mogal
Department of Surgery, Ohio State University, Columbus, OH, USA.
Carl
C
Schmidt
Department of Surgery, Ohio State University, Columbus, OH, USA.
Eliza
E
Beal
Department of Surgery, New York University, New York, NY, USA.
Ioannis
I
Hatzaras
Department of Surgery, New York University, New York, NY, USA.
Rivfka
R
Shenoy
Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA.
Shishir K
SK
Maithel
Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA. Electronic address: tpawlik1@jhmi.edu.
Timothy M
TM
Pawlik
D000368:Aged; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016208:Databases, Factual; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D018285:Klatskin Tumor / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D000072662:Margins of Excision; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011336:Probability; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States