Survival of Patients with Cholangiocarcinoma Receiving Surgical Treatment in an O. viverrini Endemic Area in Thailand: A Retrospective Cohort Study.

Satsawat Chansitthichok,Nithi Lertsawatvicha,Paiwan Wattanarath,Poowanai Sarkhampee,Pim Voravisutthikul,Parinya Chamnan

doi:10.31557/apjcp.2020.21.4.903

Satsawat Chansitthichok, Nithi Lertsawatvicha + Show 4 more

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https://doi.org/10.31557/apjcp.2020.21.4.903

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Abstract

Objective:To investigate risk factors associated with mortality in cholangiocarcinoma patients receiving surgical treatment in Thailand’s endemic area and their survival rate. Materials and Methods:Medical records of patients with histologically confirmed cholangiocarcinoma, who underwent surgical treatment at Sanpasitthiprasong Regional Hospital from October 1, 2013 to October, 31 2015, were retrospectively included. Patients’ vital status (death/alive) and date of death were obtained from the Interior Ministry’s death certificate. Cox proportional hazard regression was used to examine factors associated with mortality. Results:Out of 295 patients with cholangiocarcinoma (CCA), 180(58%) were intrahepatic CCA, 86(28%) were perihilar CCA, and 29 (9%) were distal CCA. Three groups were homogenous in terms of age and gender. Most of our patients referred with abdominal pain (63%), especially those who were intrahepatic CCA (77%). However, almost 80% of the perihilar CCA and distal CCA patients came with jaundice. Tumor markers (CEA and CA19-9) were not different between groups p=0.74 and p=0.43 respectively. Median survival of patients with intrahepatic CCA, perihilar CCA, and distal CCA patients was 14.6, 14.2, and 14.0 months, respectively. Factors independently associated with mortality in intrahepatic CCA patients were number and size of tumors and presence of perineural invasion (Hazard ratio (HR) 1.09[1.03 - 1.15], 1.07[1.02 - 1.13], and 2.09 [1.28 - 3.39], respectively). In perihilar CCA patients, having positive lymph nodes and resection status were independently associated with mortality. Compared to R0 resection, R1, R2, and no resection of perihilar CCA were associated with a 2-, 8- and 4-fold increase in the risk of mortality (HR 2.17 (0.99 – 4.78), 7.97 (3.22 – 19.71), and 4.21 (0.51 – 34.82), respectively). Conclusion:CCA patients in this endemic area had fairly poor survival. Factors associated with mortality in intrahepatic CCA were number and size of tumors and perineural invasion. However, risk factors for perihilar CCA included positive lymph nodes and resection status.

Highlights

Cholangiocarcinoma (CCA) is a malignancy originating from the biliary epithelium and peri-biliary gland
The only statistically significant outcome of dCCA based on univariate analysis was positive lymph node 6.86 (1.49 – 31.57). In this large retrospective cohort of contemporary Thai patients with CCA, it was found that the survival rate was poor to moderate with varying survival rate with respect to resection status
Factors independently associated with the risk of mortality in iCCA were resection status, number and size of tumor (s), and perineural invasion (PNI)

Summary

Introduction

Cholangiocarcinoma (CCA) is a malignancy originating from the biliary epithelium and peri-biliary gland. Factors associated with survival rate of CCA after surgery include tumor size, number of tumors, lymph node metastasis, perineural invasion (PNI), lympho-vascular invasion (LVI) and marginal status (Yamamoto and Ariizumi, 2011; Song et al, 2013; Hartog et al, 2016; Bagante et al, 2017; Jeong et al, 2017; Squadroni et al, 2017; Wellner et al, 2017).

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