Brief Article
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World J Gastrointest Oncol. Apr 15, 2013; 5(4): 81-87
Published online Apr 15, 2013. doi: 10.4251/wjgo.v5.i4.81
Prognostic factors in resectable cholangiocarcinoma patients: Carcinoembryonic antigen, lymph node, surgical margin and chemotherapy
Kosin Wirasorn, Thundon Ngamprasertchai, Jarin Chindaprasirt, Aumkhae Sookprasert, Narong Khantikaew, Ake Pakkhem, Piti Ungarereevittaya
Kosin Wirasorn, Thundon Ngamprasertchai, Jarin Chindaprasirt, Aumkhae Sookprasert, Department of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
Narong Khantikaew, Ake Pakkhem, Department of Surgery, Khon Kaen University, Khon Kaen 40002, Thailand
Piti Ungarereevittaya, Department of Pathology, Khon Kaen University, Khon Kaen 40002, Thailand
Author contributions: Wirasorn K designed research; Wirasorn K, Ngamprasertchai T performed research; Wirasorn K, Chindaprasirt J, Sookprasert A, Khantikaew N, Pakkhem A, Ungareevittaya P contributed analytical tools; Wirasorn K, Ngamprasertchai T analyzed data; Wirasorn K wrote the paper.
Supported by The Khon Kaen University Publication Clinic, Research
Correspondence to: Kosin Wirasorn, MD, Department of Medicine, Khon Kaen University, Amphur Muang, 40002 Khon Kaen, Thailand. wkosin@kku.ac.th
Telephone: +66-43-363664 Fax: +66-43-202476
Received: November 17, 2012
Revised: March 5, 2013
Accepted: March 15, 2013
Published online: April 15, 2013
Processing time: 166 Days and 5.2 Hours
Abstract

AIM: To evaluate outcomes in resectable cholangiocarcinoma patients and to determine prognostic factors.

METHODS: A retrospective study was conducted among newly-diagnosed cholangiocarcinoma patients from January 2009 to December 2011 who underwent curative resection in Srinakarind Hospital (a 1000-bed university hospital). Two hundred and sixty-three cholangiocarcinoma patients with good performance were enrolled. These patients had pathological reports with clear margins or microscopic margins. Prognostic factors which included clinical factors, serum liver function test as well as serum tumor makers at presentation, tumor data, and receiving adjuvant chemotherapy were determined by uni- and multivariate analysis.

RESULTS: The median overall survival time was 17 mo (95%CI: 13.2-20.7); and 1-, 2-, and 3- year survival rates were 65.5%, 45.2% and 35.4%. Serum albumin levels, serum carcinoembryonic antigen (CEA) levels, staging classifications by American Joint Committee on cancer, pathological tumor staging, lymph node metastases, tumor grading, surgical margin status, and if adjuvant chemotherapy was administered, were shown to be significant prognostic factors of resectable cholangiocarcinoma by univariate analysis. Multivariate analysis, however, established that only abnormal serum CEA [hazard ratio (HR) 1.68; P = 0.027] and lymph node metastases (HR 2.27; P = 0.007) were significantly associated with a decrease in overall survival, while adjuvant chemotherapy (HR 0.71; P = 0.067) and surgical margin negative (HR 0.72; P = 0.094) tended to improve survival time.

CONCLUSION: Serum CEA and lymph node metastases which were associated with advanced stage tumors become strong negative prognostic factors in cholangiocarcinoma.

Keywords: Cholangiocarcinoma; Prognosis; Carcinoembryonic antigen; Lymph nodes; Neoplasm metastasis; Surgical margin status; Hepatectomy; Chemotherapy; Adjuvant; Survival rate

Core tip: Cholangiocarcinoma has a high prevalence in the Asian countries, particularly Thailand. Cholangiocarcinoma patients usually have a high mortality rate and poor treatment outcomes. Curative surgery is the only treatment for early stages of this cancer. Cholangiocarcinoma has a high rate of recurrence. This study aimed to evaluate outcomes in resectable cholangiocarcinoma patients and to determine prognostic factors. The results demonstrated serum carcinoembryonic antigen and lymph node metastases which were associated with advanced stage tumors become strong negative prognostic factors in cholangiocarcinoma, while additional treatment including adjuvant chemotherapy and adequate surgical resection may improve survival time.