General Surgery division, Department of Surgery, Sanpasitthiprasong Hospital, Ubon Ratchathani,Thailand.
Cardiometabolic Research Group, Department of Social Medicine, Sanpasitthiprasong Hospital, Ubon Ratchathani, Thailand.
Asian Pac J Cancer Prev. 2020 Apr 1;21(4):903-909. doi: 10.31557/APJCP.2020.21.4.903.
To investigate risk factors associated with mortality in cholangiocarcinoma patients receiving surgical treatment in Thailand's endemic area and their survival rate.
Medical records of patients with histologically confirmed cholangiocarcinoma, who underwent surgical treatment at Sanpasitthiprasong Regional Hospital from October 1, 2013 to October, 31 2015, were retrospectively included. Patients' vital status (death/alive) and date of death were obtained from the Interior Ministry's death certificate. Cox proportional hazard regression was used to examine factors associated with mortality.
Out of 295 patients with cholangiocarcinoma (CCA), 180(58%) were intrahepatic CCA, 86(28%) were perihilar CCA, and 29 (9%) were distal CCA. Three groups were homogenous in terms of age and gender. Most of our patients referred with abdominal pain (63%), especially those who were intrahepatic CCA (77%). However, almost 80% of the perihilar CCA and distal CCA patients came with jaundice. Tumor markers (CEA and CA19-9) were not different between groups p=0.74 and p=0.43 respectively. Median survival of patients with intrahepatic CCA, perihilar CCA, and distal CCA patients was 14.6, 14.2, and 14.0 months, respectively. Factors independently associated with mortality in intrahepatic CCA patients were number and size of tumors and presence of perineural invasion (Hazard ratio (HR) 1.09[1.03 - 1.15], 1.07[1.02 - 1.13], and 2.09 [1.28 - 3.39], respectively). In perihilar CCA patients, having positive lymph nodes and resection status were independently associated with mortality. Compared to R0 resection, R1, R2, and no resection of perihilar CCA were associated with a 2-, 8- and 4-fold increase in the risk of mortality (HR 2.17 (0.99 - 4.78), 7.97 (3.22 - 19.71), and 4.21 (0.51 - 34.82), respectively).
CCA patients in this endemic area had fairly poor survival. Factors associated with mortality in intrahepatic CCA were number and size of tumors and perineural invasion. However, risk factors for perihilar CCA included positive lymph nodes and resection status.
探讨泰国流行地区接受手术治疗的胆管癌患者的死亡相关因素及其生存率。
回顾性纳入 2013 年 10 月 1 日至 2015 年 10 月 31 日在 Sanpasitthiprasong 地区医院接受手术治疗的经组织学证实的胆管癌患者的病历。通过内政部的死亡证明获得患者的生存状态（死亡/存活）和死亡日期。使用 Cox 比例风险回归来检查与死亡率相关的因素。
295 例胆管癌（CCA）患者中，180 例（58%）为肝内 CCA，86 例（28%）为肝门部 CCA，29 例（9%）为远端 CCA。三组在年龄和性别方面具有同质性。我们的大多数患者因腹痛就诊（63%），尤其是肝内 CCA 患者（77%）。然而，几乎 80%的肝门部和远端 CCA 患者伴有黄疸。肿瘤标志物（CEA 和 CA19-9）在各组之间无差异（p=0.74 和 p=0.43）。肝内 CCA、肝门部 CCA 和远端 CCA 患者的中位生存时间分别为 14.6、14.2 和 14.0 个月。肝内 CCA 患者死亡的独立相关因素为肿瘤数量和大小以及神经周围侵犯（风险比（HR）1.09[1.03-1.15]、1.07[1.02-1.13]和 2.09[1.28-3.39]）。在肝门部 CCA 患者中，阳性淋巴结和切除状态与死亡率独立相关。与 R0 切除相比，R1、R2 和肝门部 CCA 无切除与死亡率增加 2 倍、8 倍和 4 倍相关（HR 2.17（0.99-4.78）、7.97（3.22-19.71）和 4.21（0.51-34.82））。
该流行地区的 CCA 患者生存状况相当差。肝内 CCA 患者死亡的相关因素为肿瘤数量和大小以及神经周围侵犯。然而，肝门部 CCA 的危险因素包括阳性淋巴结和切除状态。
