Prognostic factors and long-term outcomes of hilar cholangiocarcinoma: A single-institution experience in China

Table 1 Characteristics of patients receiving curative and palliative surgery n (%)

Variable	Curative surgery (n = 381)	Palliative surgery (n = 330)
Age (median [range])	60 [26-82]	58 [19-80]
Sex, male (%)	231 (60.6)	178 (53.9)
Presenting symptoms
Jaundice	267 (70.1)	240 (72.7)
Weight loss	26 (6.8)	22 (6.7)
Abdominal pain	24 (6.3)	28 (8.5)
Nausea and vomiting	20 (5.2)	17 (5.1)
General fatigue	44 (11.6)	23 (7.0)
Tumor markers (median [range])
Preoperative CA 19-9 level, U/mL	348 [0.6-1000]	539.9 [0.6-3015.2]
Preoperative CA 125 level, U/mL	19.84 [1.23-257.70]	33.94 [1.54-1598.00]
Preoperative CEA level, ng/mL	3.23 [0.20-65.51]	4.44 [0.47-1000.00]
Liver functions (median [range])
Preoperative TB level, umol/L	209.4 [7.1-586.3]	239.65 [1.90-805.70]
Preoperative ALT level, U/L	95 [10-967]	78.5 [6.0-1212.0]
Preoperative AST level, U/L	86 [14-1016]	87 [11-927]
Preoperative Albumin level, g/L	36.7 [18.7-51.8]	35.95 [21.30-72.50]
Preoperative hospital stay (median [range])	7 [2-44]	7 [3-48]
Total hospital stay (median [range])	19 [9-113]	16 [4-102]
Portal vein embolization	53 (13.9)
Biliary drainage	201 (52.8)
Estimated blood loss (median [range])	600 [50-2000]	348 [0.6-1000]
Bismuth-Corlette classification
Type I	95 (25.2)	16 (4.8)
Type II	92 (24.2)	59 (17.9)
Type IIIa or IIIb	102 (26.8)	102 (30.9)
Type IV	92 (24.2)	153 (46.4)

ALT: Alanine aminotransferase; AST: Aspartate transaminase; CA: Carbohydrate antigen; CEA: Carcinoembryonic antigen; TB: Total bilirubin.

Table 2 Type of surgical procedures

Surgical procedures	n (%)
Curative intent surgery	381 (53.6)
Hilar bile duct resection alone	50 (13.1)
Left hemihepatectomy	142 (37.3)
Right hemihepatectomy	101 (26.5)
Left trisegmentectomy	46 (12.1)
Right trisegmentectomy	20 (5.2)
Mesohepatetctomy	22 (5.8)
Additional procedures
Caudate lobectomy	300 (78.7)
Portal vein resection	51 (13.4)
Pancreatoduodenectomy	8 (2.1)
Palliative intent surgery	330 (46.4)
Surgical palliation	266 (80.6)
Nonsurgical palliation	64 (19.4)
ERCP	35 (10.6)
PTCD	29 (8.8)

ERCP: Endoscopic retrograde cholangiopancreatography; PTCD: Percutaneous transhepatic cholangial drainage.

Table 3 Univariate analysis of prognostic factors for OS and DFS

Variables	Median OS (mo)	P value	Median DFS (mo)	P value
Tumor size
≤ 3 cm	35.2	< 0.001	19.8	< 0.001
> 3 cm	14.7		13.0
Surgical procedures
BDR	20.8	0.072	15.0	0.065
BDR + hepatectomy	27.6		18.7
Lymph node metastasis
N0	39.9	< 0.001	25.4	< 0.001
N1-2	15.7		12.3
Tumor differentiation
Well	54.1	< 0.001	25.3	< 0.001
Moderate	27.6		17.8
Poor	13.5		12.1
Resection margin
R0	35.2	< 0.001	20.6	< 0.001
R1 and R2	12.4		9.6
Presence of vascular invasion
No	26.3	0.009	19.0	< 0.001
Yes	20.9		10.6
Caudate lobe resection
Yes	35.7	0.040	21.3	< 0.001
No	21.4		15.0
CA 19-9 > 100 U/L
No	39.7	0.039	23.6	0.018
Yes	23.0		16.7
Perineural infiltration
No	27.3	0.084	22.7	0.090
Yes	20.8		15.9
T stage (AJCC)
T1 and T2	27.6	NS	19.2	0.028
T3 and T4	25.7		16.9

Additional factors not significant in univariate analysis included age, sex, gross feature, operative time, total hospital stay, preoperative biliary drainage, and Bismuth-Corlett classification. AJCC: American Joint Committee on Cancer; BDR: Hilar bile duct resection; CA: Carbohydrate antigen; DFS: Disease-free survival; NS: Not significant; OS: Overall survival.