Clinical Research
Copyright ©2007 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Mar 7, 2007; 13(9): 1422-1426
Published online Mar 7, 2007. doi: 10.3748/wjg.v13.i9.1422
Long-term outcome and prognostic factors of patients with hilar cholangiocarcinoma
Andreas Weber, Sonja Landrock, Jochen Schneider, Manfred Stangl, Bruno Neu, Peter Born, Meinhard Classen, Thomas Rösch, Roland M Schmid, Christian Prinz
Andreas Weber, Sonja Landrock, Jochen Schneider, Bruno Neu, Peter Born, Meinhard Classen, Roland M Schmid, Christian Prinz, Department of Internal Medicine II, Technical University of Munich, Germany
Manfred Stangl, Department of Surgery, Technical University of Munich, Germany
Thomas Rösch, Department of Internal Medicine, Rudolf Virchow Klinikum Charite, Berlin, Germany
Author contributions: All authors contributed equally to the work.
Correspondence to: Christian Prinz, Professor, II Medizinische Klinik, Klinikum rechts der Isar der Technischen Universität München, Ismaningerstr. 22, 81675 München,Germany. christian.prinz@lrz.tum.de
Telephone: +49-89-41405973 Fax: +49-89-41407366
Received: October 21, 2006
Revised: December 1, 2006
Accepted: February 12, 2007
Published online: March 7, 2007
Abstract

AIM: To evaluate the long-term outcome and prognostic factors of patients with hilar cholangiocarinoma.

METHODS: Ninety-six consecutive patients underwent treatment for malignant hilar bile duct tumors during 1995–2005. Of the 96 patients, 20 were initially treated with surgery (n = 2 R0 / n = 18 R1). In non-operated patients, data analysis was performed retrospectively.

RESULTS: Among the 96 patients, 76 were treated with endoscopic transpapillary (ERC, n = 45) and/or percutaneous transhepatic biliary drainage (PTBD, n = 31). The mean survival time of these 76 patients undergoing palliative endoscopic and/or percutaneous drainage was 359 ± 296 d. The mean survival time of patients with initial bilirubin levels > 10 mg/dL was significantly lower (P < 0.001) than patients with bilirubin levels < 10 mg/dL. The mean survival time of patients with Bismuth stage II (n = 8), III (n = 28) and IV (n = 40) was 496 ± 300 d, 441 ± 385 d and 274 ± 218 d, respectively. Thus, patients with advanced Bismuth stage showed a reduced mean survival time, but the difference was not significant. The type of biliary drainage had no significant beneficial effect on the mean survival time (ERC vs PTBD, P = 0.806).

CONCLUSION: Initial bilirubin level is a significant prognostic factor for survival of patients. In contrast, age, tumor stage according to the Bismuth-Corlette classification, and types of intervention are not significant prognostic parameters for survival. Palliative treatment with endoscopic or percutaneous biliary drainage is still suboptimal, new diagnostic and therapeutic tools need to be evaluated.

Keywords: Klatskin tumor; Cholangiocarcinoma; Bilirubin; Prognostic factors; Endoscopic therapy; Operative therapy; Survival; Bismuth stage