Department of Internal Medicine, University Hospital 12 de Octubre, Avenue Córdoba, s/n, Universidad Complutense, Madrid 28041, Spain.
World J Gastroenterol. 2009 Nov 14;15(42):5279-86. doi: 10.3748/wjg.15.5279.
To study the outcome and prognostic factors in a series of patients with extrahepatic cholangiocarcinoma and determine the impact of comorbidity on survival.
A retrospective analysis of 68 patients with extrahepatic cholangiocarcinoma (perihilar, n=37; distal, n=31) seen at a single tertiary-care institution during the period 1999-2003 was performed. Data on presentation, management, and outcome were assessed by chart review. Pathologic confirmation was obtained in 37 cases (54.4%). Comorbidity was evaluated by using the Charlson comorbidity index (CCI).
Mean age at diagnosis was 73.4+/-11.5 years. Jaundice was the most common symptom presented (86.8%). Median CCI score was 1 (range, 0 to 4). Nineteen patients (27.9%) underwent tumor resection. Palliative biliary drainage was performed in 39 patients (57.4%), and 6 patients (8.8%) received only best supportive care. Tumor-free margin status (R0) was achieved in 15 cases (78.9% of resection group). Baseline serum carbohydrate antigen 19-9 (CA 19-9) level was revealed to be an independent predictor of surgical treatment (P=0.026). Overall median survival was 3.1+/-0.9 mo, with 1- and 2-year survival rates of 21% and 7%, respectively. In the univariate analysis, tumor resection, CCI score, and serum CA 19-9 levels correlated significantly with outcome. In the multivariate analysis, only resection (HR 0.10; 95% CI, 0.02-0.51, P=0.005) and a CCI score>or=2 (HR 3.36; 95% CI, 1.0-10.9, P=0.045) were found to independently predict survival.
Tumor resection and comorbidity emerged as significant prognostic variables in extrahepatic cholangiocarcinoma. Comorbidity evaluation instruments should be applied in the clinical management of such patients.
研究一系列肝外胆管癌患者的预后和相关因素，并确定合并症对生存的影响。
对 1999 年至 2003 年期间在一家三级医疗中心就诊的 68 例肝外胆管癌患者（肝门部，n=37；远端，n=31）进行回顾性分析。通过病历回顾评估患者的临床表现、治疗和预后。37 例（54.4%）获得病理证实。采用 Charlson 合并症指数（CCI）评估合并症。
诊断时的平均年龄为 73.4+/-11.5 岁。最常见的症状是黄疸（86.8%）。CCI 中位数为 1（范围 0-4）。19 例（27.9%）患者接受了肿瘤切除术。39 例（57.4%）患者进行了姑息性胆道引流，6 例（8.8%）患者仅接受最佳支持治疗。在肿瘤切除组中，15 例（78.9%）获得无肿瘤切缘（R0）。术前血清碳水化合物抗原 19-9（CA 19-9）水平是手术治疗的独立预测因素（P=0.026）。总的中位生存期为 3.1+/-0.9 个月，1 年和 2 年生存率分别为 21%和 7%。单因素分析显示，肿瘤切除、CCI 评分和血清 CA 19-9 水平与预后显著相关。多因素分析显示，只有肿瘤切除（HR 0.10；95%CI，0.02-0.51，P=0.005）和 CCI 评分≥2（HR 3.36；95%CI，1.0-10.9，P=0.045）是独立的预后预测因素。
肿瘤切除和合并症是肝外胆管癌的重要预后因素。应在临床管理中应用合并症评估工具。
