Survival of 736 Cholangiocarcinoma Patient Receiving Surgical Treatment in O. Viverrini Endemic Area, Thailand

Abstract

Introduction: Cholangiocarcinoma is a common cancer in Thailand, endemic area of O. Viverrini. This study aims to investigate survival outcome and prognostic factors in Cholangiocarcinoma patient receiving surgical treatment. Methods: We retrospectively reviewed 736 consecutive patients with cholangiocarcinoma who underwent surgical treatment between October 2013 to December 2018. Patients were divided into Intrahepatic (iCCA), perihilar (pCCA) and distal (dCCA) groups. Principle outcomes were long-term survival and 90-day mortality. Results: Of the 736 patients, 407 (55%) were iCCA, 240 (33%) were pCCA and 89 (12%) were dCCA. Overall resectable rate was 78.3%; 75.2% in iCCA, 83.8% in pCCA and 77.5% in dCCA. In resectable patients, overall 90-day mortality was 10.9%; 11.0% in iCCA, 11.6% in pCCA and 8.9% in dCCA. Long-term survival for resectable patients was higher in patients with CA19-9 <200 U/mL (p<0.001), intraductal growth type (p<0.001), well-differentiation (p=0.001), negative nodal status (p<0.001), R0 margin (p<0.001), absence of LVI (p=0.001), absence of PNI (p<0.001) and absence of metastasis (p<0.001). In mutivariale analysis, R0 margin (p=0.001), negative nodal status (p=0.003) and absence of metastasis (p=0.002) were significant independent prognostic factors. The median survival was better in resectable group than unresectable group (11.6 vs 3.2 months, respectively, p<0.001). Furthermore, the median survivals for R0-resection with pM0 was 19.3 months (18.2, 24.5 and 18.4 in iCCA, pCCA and dCCA, respectively). Conclusion: Negative resection margin, absence of LN and absence of distant metastasis were the important factor affecting survival in CCA patients in the endemic area of O. Viverini.