Analysis Of Prognostic Factors And Surgical Treatment Of Hilar Cholangiocarcinoma

Research Background:Hilar cholangiocarcinoma(HC) is still one of malignant tumors difficult to deal with in the department of hepatobiliary surgery. With the improvement of diagnostic technology, We find more of this kind of cases. The therapeutic strategy centers on surgical resection, but the rate of thorough excision is relatively low and the recurrence rate is too high to reach a long-term satisfactory prognosis.Research Purpose:Make an analysis of the surgical treatment and the prognosis of Hilar cholangiocarcinoma after surgical resection.Methods:Make a retrospective analysis of the data of patients who have received surgical resection during January 2010 to January 2014. According to the medical records and follow-up data, we conducted separate single factor’s analysis of sex、age、Bismuth-Corlette type of tumors、preoperative DBIL level、preoperative serum CA-199 level、 clinical feature、diameter of tumor、lymph node metastasis、invasion of Portal vein、excision marg、TNM staging and differentiated degree of tumor. Then further made a multiple factors’analysis of those which may affect the prognosis. We use SPSS 17.0 as our statistical software,and estimated the survival rate% median survival time and other data by Kaplan-Meier analysis, made single factor analysis by Log-rank test, analyzed the independent risk factors by Cox regression analysis. P<0.05 means there is statistical significance.Results:There are 75 patients who meet our selection criteria, which includes 51 males,24 females, The average age is 61. Postoperative survival time of patients varies from 6 to 50 months, the median survival time is 19 months, the postoperative one-year% two-year% three-year survival rate is 80.0%、27.7%、11.5% separately. The results by single factor analysis show:The postoperative one-year、two-year、 three-year survival rate of patients whose diameter of tumor exceeds 2cm is 76.8%、23.7%、6.4% separately, while that of the patients whose diameter of tumor didn’t exceed 2cm is 85.3%、35.1%、19.4% separately, the difference between two groups has statistical significance(p=0.038). The postoperative one-year、two-year、three-year survival rate of patients who got Ro excision edge is 89.2%、39.3%、16.8% separately, while that of the patients who didn’t get Ro excision edge is 70.2%、 16.5%、5.7% separately, the difference between two groups has statistical significance(p=0.021). The postoperative one-year、two-year、 three-year survival rate of patients who had metastasis oflymph node is 68.6%、16.1%、0 separately, while that of the patients who didn’t have metastasis oflymph node is 83.6%、32.0%、14.9% separately, the difference between two groups has statistical significance(p=0.044). The postoperative one-year、two-year、three-year survival rate of patients who had invasion of portal vein is 79.1%、15.2%、3.1% separately, while that of the patients who didn’t have invasion of portal vein is 80.7%、38.0%、17.8% separately, the difference between two groups has statistical significance(p=0.010). The postoperative one-year、two-year、three-year survival rate of patients whose tumor stagingis in TNM I is 88.9%、76.5%、38.3% separately, that of the patients whose tumor stagingis in TNM II is 84.3%、31.8%、21.1% separately, that of the patients whose tumor stagingis in TNM III is 84.0%、24.0%、4.4% separately, and that of the patients whose tumor stagingis in TNM IV is 66.4%、9.6%、0 separately, the difference between different groups has statistical significance(p＜0.001). The paired comparison on layer level shows that the difference between group I and group III has statistical significance(p=0.002), and difference between group IV and group Ⅰ、Ⅱ、Ⅲ also has statistical significance(P<0.001, p=0.010, p=0.041). The postoperative one-year、 two-year、three-year survival rate of patients who were with well-differentiated tumors is 89.5%、53.0%、21.4% separately, that of the patients who were with moderately differentiated tumors is 81.4%、 26.3%、10.0% separately, that of the patients who were with poorly differentiated tumors is 69.6%、9.0%、4.4% separately, the difference between different groups has statistical significance(p=0.002). The paired comparison on layer level shows that the difference between well-differentiated group and poorly differentiated group has statistical significance (p=0.002). And the difference between moderately differentiatedgroup and poorly differentiated group also has statistical significance (p=0.013).On the whole, it indicates that the six factors described before may affect the prognosis after surgical resection.In the contrast, the single factor analysis shows that sex、age、 Bismuth-Corlette type of tumor、preoperative DBIL level、preoperative CA-199 level and clinical feature will not affect the prognosis after surgery. The further Cox multi-factor analysis shows that surgical margin(p=0.041)、TNM staging (p=0.038)and differential degree(p=0.045)of tumors are independent risk factorsConclusions:Patients who are with tumors of which diameters exceed 2cm, or who have lymph node metastasis or invasion of portal vein, or who are without Ro excision edge after surgery, or whose tumors are low differential or in a high TNM staging usually have worse prognosis after tumor resection than those are in opposite condition. Late TNM stagings positivesurgical margin and poor differentiation degree of tumor are independent risk factors that affect the prognosis. Early diagnosis and early resection should be advocated for the treatment of hilar cholangiocarcinoma.