Intrahepatic versus extrahepatic cholangiocarcinoma: Is there a difference in survival?

Abstract

15564 Background: Cholangiocarcinoma remains as a therapeutic challenge with surgery often being the only curative option. Recently, it has been described that patients with resectable tumors have median survival of 59 months versus 9 months in patients with unresectable disease. In this retrospective study, we analyze data comparing survival in intrahepatic cholangiocarcinoma (IHCC) versus extrahepatic cholangiocarcinoma (EHCC) across the Veterans Affairs (VA) Medical centers. Methods: The VA Central Cancer Registry (VACCR) is a function of the Chief, Program Office for Oncology at VA Headquarters in Washington DC. We queried the VACCR database for all diagnosed bile duct cancer cases between 1995 and 2005 using primary site code 221 (IHCC) and 240 (EHCC). The data was transformed, entered and analyzed using SPSS v.13.0. Patient and disease characteristics were compared using chi-square test. Overall survival was estimated with Kaplan-Meier method. Results: A total of 825 cases of cholangiocarcinoma were identified, of which 340 (41.2%) were IHCC and 485 (58.8%) were EHCC. Overall 122 (14.8%) patients were black (IHCC=52, 15.3%; EHCC=70, 14.4%; p=0.123). In those with IHCC, 78 (22.9%) had metastatic disease vs. 80 (16.5%) in EHCC (p<0.001). Surgery was more likely to be performed in EHCC than IHCC (26% vs. 9.1%; p<0.001). Median survival in EHCC was 5.97 months vs. 3.67 months in IHCC (p<0.001). Surgery significantly increased overall survival in both groups (table). Conclusion: IHCC and EHCC remain as therapeutic challenges. Surgical resection is the mainstay of therapy in VA patients with cholangiocarcinoma and has been shown to increase survival of these patients. Although surgical resection was performed more often in EHCC than IHCC, survival was similar in both if surgical resection was achieved. Surgery did increase overall survival in both groups. Overall Survival in IHCC and EHCC Survival (months) IHCC EHCC p-value All cases 3.67 5.97 <0.001 Metastasis 2.17 2.93 0.45 No Mets 5 6.57 0.374 Surgery 13.63 13.47 <0.001 No Surgery 3.13 4.4 <0.001 No significant financial relationships to disclose.