title: Cholangiocarcinoma with spinal metastasis: Single center survival analysis.
abstract: The aim of this study was to perform a survival analysis of Cholangiocarcinoma (CCA) with spinal metastases. 55 cases of CCA with spinal metastases were retrospectively reviewed. We recorded age, sex, Kanofsky performance score, Frankel scale, number and region of affected vertebrae, presence of appendicular bone metastases, treatment received, and survival time; then performed a survival analysis. Overall median survival was 4months (95%CI, 2.89-5.11). Frankel A had the poorest survival (2months-95%CI, 1.15-2.85) compared to Frankel C and D (P=0.004 and <0.001, respectively). One-level spinal metastasis had the longest survival (8months-95%CI, 5.98-10.02) compared to two-level and more than two-level involvement (P=0.036 and 0.001, respectively). The higher Kanofsky score had the longer survival (11months-95%CI, 9.61-12.39) compared with the low and moderate score groups (P<0.001 and 0.012, respectively). Radiation therapy had a survival of 6months (95%CI, 3.41-8.59), significantly longer than the 3months for palliative spine surgery and 2months for palliative treatment alone. CCA resection and palliative spine surgery-when performed together and/or combined with other adjuvant treatment(s)-had a survival time of longer than 9months. In conclusion, CCA with spinal metastases had a poor median survival. A single level of affected spine, a Frankel scale of C or better, a moderate to high Kanofsky score, and radiation therapy were associated with significantly longer median survival. CCA resection and spinal surgery may play an important role in prolonging survival when used in conjunction with other adjuvant treatment modalities.
authors.affiliation: Department of Orthopedics, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand.
authors.forename: Pawalee
authors.initials: P
authors.lastname: Dowsiriroj
authors.affiliation: Department of Orthopedics, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand. Electronic address: permpa@kku.ac.th.
authors.forename: Permsak
authors.initials: P
authors.lastname: Paholpak
authors.affiliation: Department of Orthopedics, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand.
authors.forename: Winai
authors.initials: W
authors.lastname: Sirichativapee
authors.affiliation: Department of Orthopedics, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand.
authors.forename: Taweechok
authors.initials: T
authors.lastname: Wisanuyotin
authors.affiliation: Department of Orthopedics, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand.
authors.forename: Pat
authors.initials: P
authors.lastname: Laupattarakasem
authors.affiliation: Department of Orthopedics, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand.
authors.forename: Kamolsak
authors.initials: K
authors.lastname: Sukhonthamarn
authors.affiliation: Department of Orthopedics, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand.
authors.forename: Weerachai
authors.initials: W
authors.lastname: Kosuwon
authors.affiliation: Department of Orthopedics, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand.
authors.forename: Polasak
authors.initials: P
authors.lastname: Jeeravipoolvarn
mesh_terms: D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery; D018281:Cholangiocarcinoma / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery; D005260:Female; D006801:Humans; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013125:Spinal Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000556:secondary / Q000601:surgery; D016019:Survival Analysis
keywords: CCA resection; Cholangiocarcinoma; Metastasis; Spinal metastasis; Spine; Survival analysis