Brief Article
Copyright ©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Nov 14, 2009; 15(42): 5279-5286
Published online Nov 14, 2009. doi: 10.3748/wjg.15.5279
Comorbidity negatively influences prognosis in patients with extrahepatic cholangiocarcinoma
Mario Fernández-Ruiz, Juan-Manuel Guerra-Vales, Francisco Colina-Ruizdelgado
Mario Fernández-Ruiz, Juan-Manuel Guerra-Vales, Department of Internal Medicine, University Hospital “12 de Octubre”, Avenue Córdoba, s/n, Universidad Complutense, Madrid 28041, Spain
Francisco Colina-Ruizdelgado, Hospital Tumor Registry, University Hospital “12 de Octubre”, Avenue Córdoba, s/n, Universidad Complutense, Madrid 28041, Spain
Author contributions: Fernández-Ruiz M and Guerra-Vales JM designed the research; Fernández-Ruiz M performed the research; Fernández-Ruiz M analyzed the data; Fernández-Ruiz M and Guerra-Vales JM wrote the paper; Guerra-Vales JM and Colina-Ruizdelgado F revised the final manuscript.
Correspondence to: Mario Fernández-Ruiz, MD, Department of Internal Medicine, University Hospital “12 de Octubre”, Avenue Córdoba, s/n, Universidad Complutense, Madrid 28041, Spain. mario_fdezruiz@yahoo.es
Telephone: +34-91-7639959 Fax: +34-91-7639959
Received: September 16, 2009
Revised: October 12, 2009
Accepted: October 19, 2009
Published online: November 14, 2009
Abstract

AIM: To study the outcome and prognostic factors in a series of patients with extrahepatic cholangiocarcinoma and determine the impact of comorbidity on survival.

METHODS: 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).

RESULTS: 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 ≥ 2 (HR 3.36; 95% CI, 1.0-10.9, P = 0.045) were found to independently predict survival.

CONCLUSION: 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.

Keywords: Charlson index; Cholangiocarcinoma; Comorbidity; Prognosis; Survival