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Clinical features and survival outcome of locally advanced extrahepatic cholangiocarcinoma.

Lee SJ, Kwon W, Kang MJ, Jang JY, Chang YR, Jung W, Kim SW - Korean J Hepatobiliary Pancreat Surg (2014)

Bottom Line: The median survival, 3- and 5-YSR of PR were 23 months, 32.1% and 13.1%, respectively.For NR, they were 9 months, 3.9% and 0%, which were significantly worse than PR (p<0.001).Regional lymph node metastasis (RR, 2.084; 95% CI, 1.491-2.914; p<0.001), non-resections (RR, 2.270; 95% CI, 1.497-3.443; p<0.001), and no chemotherapy (RR, 1.604; 95% CI, 1.095-2.349; p=0.015) were identified as risk factors for poor outcome on multivariate analysis.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.

ABSTRACT

Backgrounds/aims: Little is known about clinical features and survival outcome in locally advanced unresectable extrahepatic cholangiocarcinoma (EHC). The aim was to investigate the clinical features and the survival outcome in these patients, and to evaluate the role of palliative resections in locally advanced unresectable EHC.

Methods: Between 1995 and 2007, 280 patients with locally advanced unresectable EHC were identified. Clinical, pathologic, and survival data were investigated. A comparative analysis was done between those who received palliative resection (PR) and those who were not operated on (NR).

Results: The overall median survival of the study population was 10±1 months, and the 3- and 5-year survival rates (YSR) were 8.5% and 2.5%, respectively. The median survival, 3- and 5-YSR of PR were 23 months, 32.1% and 13.1%, respectively. For NR, they were 9 months, 3.9% and 0%, which were significantly worse than PR (p<0.001). In univariate analysis, T classification, N classification, tumor location, palliative resection, adjuvant treatment, chemotherapy, and radiation therapy were factors that showed survival difference between PR and NR. Regional lymph node metastasis (RR, 2.084; 95% CI, 1.491-2.914; p<0.001), non-resections (RR, 2.270; 95% CI, 1.497-3.443; p<0.001), and no chemotherapy (RR, 1.604; 95% CI, 1.095-2.349; p=0.015) were identified as risk factors for poor outcome on multivariate analysis.

Conclusions: Without evidence of systemic disease, palliative resection may provide some survival benefit in selected locally advanced unresectable EHCs and adjuvant treatment may further improve survival outcome.

No MeSH data available.


Related in: MedlinePlus

Management algorithm for locally advanced EHC is depicted.
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Figure 5: Management algorithm for locally advanced EHC is depicted.

Mentions: Based on our findings, an algorithm may be proposed for locally advanced unresectable EHCs. An EHC patient without evidence of systemic disease should undergo surgical exploration. Even if the tumor is found to be unresectable, the extent of tumor should be evaluated. Should the extent of tumor be equal or less than T3, palliative resection should be performed. However, should the extent of tumor be compatible with T4, resection is no longer necessary and only bypass operation should be done as necessary. Adjuvant treatment should be done. This algorithm is summarized in Fig. 5.


Clinical features and survival outcome of locally advanced extrahepatic cholangiocarcinoma.

Lee SJ, Kwon W, Kang MJ, Jang JY, Chang YR, Jung W, Kim SW - Korean J Hepatobiliary Pancreat Surg (2014)

Management algorithm for locally advanced EHC is depicted.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4492336&req=5

Figure 5: Management algorithm for locally advanced EHC is depicted.
Mentions: Based on our findings, an algorithm may be proposed for locally advanced unresectable EHCs. An EHC patient without evidence of systemic disease should undergo surgical exploration. Even if the tumor is found to be unresectable, the extent of tumor should be evaluated. Should the extent of tumor be equal or less than T3, palliative resection should be performed. However, should the extent of tumor be compatible with T4, resection is no longer necessary and only bypass operation should be done as necessary. Adjuvant treatment should be done. This algorithm is summarized in Fig. 5.

Bottom Line: The median survival, 3- and 5-YSR of PR were 23 months, 32.1% and 13.1%, respectively.For NR, they were 9 months, 3.9% and 0%, which were significantly worse than PR (p<0.001).Regional lymph node metastasis (RR, 2.084; 95% CI, 1.491-2.914; p<0.001), non-resections (RR, 2.270; 95% CI, 1.497-3.443; p<0.001), and no chemotherapy (RR, 1.604; 95% CI, 1.095-2.349; p=0.015) were identified as risk factors for poor outcome on multivariate analysis.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.

ABSTRACT

Backgrounds/aims: Little is known about clinical features and survival outcome in locally advanced unresectable extrahepatic cholangiocarcinoma (EHC). The aim was to investigate the clinical features and the survival outcome in these patients, and to evaluate the role of palliative resections in locally advanced unresectable EHC.

Methods: Between 1995 and 2007, 280 patients with locally advanced unresectable EHC were identified. Clinical, pathologic, and survival data were investigated. A comparative analysis was done between those who received palliative resection (PR) and those who were not operated on (NR).

Results: The overall median survival of the study population was 10±1 months, and the 3- and 5-year survival rates (YSR) were 8.5% and 2.5%, respectively. The median survival, 3- and 5-YSR of PR were 23 months, 32.1% and 13.1%, respectively. For NR, they were 9 months, 3.9% and 0%, which were significantly worse than PR (p<0.001). In univariate analysis, T classification, N classification, tumor location, palliative resection, adjuvant treatment, chemotherapy, and radiation therapy were factors that showed survival difference between PR and NR. Regional lymph node metastasis (RR, 2.084; 95% CI, 1.491-2.914; p<0.001), non-resections (RR, 2.270; 95% CI, 1.497-3.443; p<0.001), and no chemotherapy (RR, 1.604; 95% CI, 1.095-2.349; p=0.015) were identified as risk factors for poor outcome on multivariate analysis.

Conclusions: Without evidence of systemic disease, palliative resection may provide some survival benefit in selected locally advanced unresectable EHCs and adjuvant treatment may further improve survival outcome.

No MeSH data available.


Related in: MedlinePlus