Sathitruangsak Chirawadee, Pattarapuntakul Tanawat, Kaewdech Apichat, Thongkan Tortrakoon, Prisutkul Apinya, Thongwatchara Phatcharaporn, Sriplung Hutcha, Kongkamol Chanon, Kanokwiroon Kanyanatt, Obchoei Sumalee, Sripongpun Pimsiri
Holistic Center for Cancer Study and Care (HOCC-PSU) and Medical Oncology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
Gastroenterology and Hepatology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
Cancer Med. 2024 Dec;13(24):e70491. doi: 10.1002/cam4.70491.
Cholangiocarcinoma (CCA) is most commonly seen in Northeastern Thailand and other parts of Asia where liver flukes are prevalent. However, it is unknown whether CCA patients in low and high liver fluke prevalence areas are similar. This study aimed to analyze the clinical characteristics and outcomes of CCA patients in Southern Thailand.
We retrospectively reviewed 223 patients diagnosed with CCA between 2018 and 2021 in a tertiary-care center. Clinicopathologic data were reviewed and compared between intrahepatic, perihilar, and distal CCA (iCCA, pCCA, and dCCA, respectively). Overall survivals (OS) were determined by Kaplan-Meier method and multivariable Cox regressions.
The mean age was 63.9 years; 50.7% were men. The most common subtype was iCCA (49.3%), followed by pCCA (36.3%) and dCCA (14.3%). Most patients were diagnosed at a later stage: 59.4% TMN stage IV and 23.3% stage III. Cirrhosis was present in 6.3%, while the presence of liver fluke was not detected. Only 15.1% of the cohort were deemed resectable. The median OS for iCCA, pCCA, and dCCA patients were 27.3, 22.0, and 19.3 weeks, respectively (p = 0.9). One-year survival rate differed significantly between resectable and unresectable patients (85.2% vs. 21.2%, p < 0.0001). TMN stage (aHR 1.88), palliative biliary drainage (aHR 0.31), and systemic chemotherapy (aHR 0.19) were independent predictors for mortality in unresectable pCCA and dCCA patients. In unresectable iCCA patients, only systemic chemotherapy was significant (aHR 0.30).
Most patients were diagnosed late, and the median OS was only 5-6 months. Unresectable CCA patients with systemic chemotherapy and palliative biliary drainage had better survival rates.
胆管癌（CCA）在泰国东北部及亚洲其他肝吸虫流行地区最为常见。然而，肝吸虫低流行区和高流行区的CCA患者是否相似尚不清楚。本研究旨在分析泰国南部CCA患者的临床特征和预后。
我们回顾性分析了2018年至2021年在一家三级医疗中心诊断为CCA的223例患者。对肝内、肝门周围和远端CCA（分别为iCCA、pCCA和dCCA）的临床病理数据进行回顾和比较。总生存期（OS）采用Kaplan-Meier法和多变量Cox回归分析。
平均年龄为63.9岁；50.7%为男性。最常见的亚型是iCCA（49.3%），其次是pCCA（36.3%）和dCCA（14.3%）。大多数患者在晚期确诊：59.4%为TMN IV期，23.3%为III期。6.3%的患者存在肝硬化，未检测到肝吸虫。该队列中只有15.1%的患者被认为可切除。iCCA、pCCA和dCCA患者的中位OS分别为27.3周、22.0周和19.3周（p = 0.9）。可切除和不可切除患者的1年生存率差异显著（85.2%对21.2%，p < 0.0001）。TMN分期（aHR 1.88）、姑息性胆道引流（aHR 0.31）和全身化疗（aHR 0.19）是不可切除的pCCA和dCCA患者死亡的独立预测因素。在不可切除的iCCA患者中，只有全身化疗具有显著意义（aHR 0.30）。
大多数患者确诊时已处于晚期，中位OS仅为5至6个月。接受全身化疗和姑息性胆道引流的不可切除CCA患者生存率更高。
