| Background and objectives:Hilar cholangiocarcinoma (HCC) is a rare neoplasm, accounting for less than1%of all cancers. Nevertheless, the prognosis of HCC was poor, this study was designed to analysis and determine the prognostic factors of patients with HCC underwent RO resection.Methods:A retrospective review of79cases with HCC underwent RO resection between March2003and February2012in Qilu Hospital of Shandong University was carried out. Clinicopathological and serum features including patients’ gender, age, Bismuth-Corlette classification, tumor size, degree of tumor differentiation, pathological classification, T stage, lymph node metastasis (N), clinical TNM staging, surgical approach, serum CEA level, the highest preoperative total bilirubin level were analyzed. Single factor analysis was performed to determine the prognostic factors, and Cox regression model for multivariate analysis was applied to understand the independent factors influencing the postoperative survival rate. SPSS version17.0was used to perform all statistical analyses. The nonparametric approach of Kaplan-Meier curves with a log-rank test was used to calculate survival rate, the mean and median survival time. Moreover, Cox regression model (Hazard ratio model) was employed to perform multi-factor analysis, thus the predictive factors could be detected. Significance was set as no more than0.05.Results:The1-year,3-year,5-year survival rate of elder patients (≥60years) were55.6%,25.7%and9.6%respectively. The mean and median survival time were27.7±5.9months and13.0±1.8months respectively. The1-year,3-year,5-year survival rate of younger patients (<60years) were69.6%,39.5%,19.5%respectively. The mean and median survival time was47.1±7.5months and19.0±7.9months respectively. The difference has statistical significance (x2=3.859, P=0.05). The1-year,3-year,5-year survival rate of well-differentiated tumor were76.7%、54.8%、27.4%respectively. The mean and median survival time were46.1±7.5months and37±10.8months respectively. The1-year,3-year,5-year survival rate of moderate-differentiated tumor were68.4%,28.5%,0. The mean and median survival time was35.0±9.0months and15.0±2.4months respectively. The1-year,3-year,5-year survival rate of poor/non-differentiated tumor were30.7%,10.2%,0. The mean and median survival time was18.3±8.0months and12.0±2.3months respectively. The difference has statistical significance (x2=7.984, P=0.018). The difference between well differentiation and poor/unknown differentiation has statistical significance (x2=7.620, P=0.006).The1-year,3-year,5-year survival rate of those had no lymph node metastasis (NO) were84.3%,41.4%,28.9%respectively. The mean and median survival time were42.1±5.9months and30.0±8.6months respectively. The1-year,3-year,5-year survival rate of those with lymph node metastasis were27.0%,9.0%,0respectively. The mean and median survival time was18.4±7.3months and12.0±1.2months respectively. The difference has statistical significance (x2=3.922, P=0.048).The1-year,3-year,5-year survival rate of the patients whose serum CEA level was higher than normal were70.9%,13.8%and0respectively. The mean and median survival time were23.1±5.0months and13.0±1.5months respectively. The1-year,3-year,5-year survival rate of those with normal serum CEA level were79.9%,44.7%,37.2%respectively. The mean and median survival time was45.4±6.7months and19.0±8.5months respectively. The difference has statistical significance (x2=4.329,P=0.037).Then we concluded that the above-mentioned four factors (Patients’ age, degrees of tumor differentiation, lymph node metastasis (N), serum CEA level) were the prognostic factors of HCC. Elder patients, poor or unknown tumor differentiation, lymph node metastasis, and higher serum CEA level correlate with shorter survival time. While, the other8factors were not the prognostic factors of HCC. Meanwhile, the results of Cox regression of multi-factor analysis betrayed the fact that tumor differentiation was the independent prognostic factor of HCC (P=0.05), and poor or unknown differentiation indicates higher mortality risk, which could be up to2.492times of well differentiation.Conclusion:Patients’ age, degrees of tumor differentiation, lymph node metastasis (N), serum CEA level were related factors of prognosis in HCC. Elder patients, poor or unknown tumor differentiation, lymph node metastasis, and higher serum CEA level always correlate with shorter survival time. Tumor differentiation was the independent predictive factor of HCC, and poor/unknown differentiation indicates higher mortality risk. |
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