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Journal of Gastrointestinal Surgery
Published in: Journal of Gastrointestinal Surgery 5/2013

01-05-2013 | Original Article

Resection for Hilar Cholangiocarcinoma: Analysis of Prognostic Factors and the Impact of Systemic Inflammation on Long-term Outcome

Authors: Traian Dumitrascu, Dragos Chirita, Mihnea Ionescu, Irinel Popescu

Published in: Journal of Gastrointestinal Surgery | Issue 5/2013

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Abstract

Introduction

Resection for hilar cholangiocarcinoma is the single hope for long-term survival.

Methods

Ninety patients underwent curative intent surgery for hilar cholangiocarcinoma between 1996 and 2012. The potential prognostic factors were assessed by univariate (Kaplan–Meier curves and log-rank test) and multivariate analyses (Cox proportional hazards model).

Results

The median overall and disease-free survivals were 26 and 17 months, respectively. The multivariate analysis identified R0 resection (HR = 0.03, 95 % CI 0–0.19, p < 0.001), caudate lobe invasion (HR = 6.33, 95 % CI 1.31–30.46, p = 0.021), adjuvant gemcitabine-based chemotherapy (HR = 0.38, 95 % CI 0.15–0.94, p = 0.037), and the neutrophil-to-lymphocyte ratio (HR = 0.78, 95 % CI 0.62–0.98, p = 0.036) as independent prognostic factors for disease-free survival. The independent prognostic factors for overall survival were R0 resection (HR = 0.03, 95 % CI 0–0.22, p < 0.001), caudate lobe invasion (HR = 11.75, 95 % CI 1.65–83.33, p = 0.014), and adjuvant gemcitabine-based chemotherapy (HR = 0.19, 95 % CI 0.06–0.56, p = 0.003).

Conclusions

The negative resection margin represents the most important prognostic factor. Adjuvant gemcitabine-based chemotherapy appears to benefit survival. The neutrophil-to-lymphocyte ratio may potentially be used to stratify patients for future clinical trials.
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Metadata
Title
Resection for Hilar Cholangiocarcinoma: Analysis of Prognostic Factors and the Impact of Systemic Inflammation on Long-term Outcome
Authors
Traian Dumitrascu
Dragos Chirita
Mihnea Ionescu
Irinel Popescu
Publication date
01-05-2013
Publisher
Springer-Verlag
Published in
Journal of Gastrointestinal Surgery / Issue 5/2013
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-013-2144-2

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