Nakeeb A, Pitt HA, Sohn TA, et al. (1996) Cholangiocarcinoma. A spectrum of intrahepatic, perihilar, and distal tumors. Ann Surg, 224(4):463-473; discussion 473-465
Statistical Analysis
All data are presented as percentage of patients or mean ± standard error of the mean. Percentages were compared by chi square analysis, and means were analyzed by analysis of variance. Survival curves were constructed by the Kaplan-Meier technique and were compared by the log-rank test. Cox's proportional hazard survival analysis was used to determine which parameters affected survival. A p value < 0.05 was considered significant.
Survival
The 5-year actuarial survival for all 294 patients with cholangiocarcinoma was 10%, and the median survival was 14 months. No patient whose tumor was not resected has survived 5 years after surgery, and the median survival was 8 months.The overall 5-year actuarial survival rates for the intrahepatic, perihilar, and distal tumors were 23%, 6%, and 24%, respectively. Actuarial survival for intrahepatic, perihilar, and distal tumors stratified by resection versus palliation is presented in Figures 4A, B, and C. The 5-year survival rates for the resected intrahepatic, perihilar, and distal tumors were 44%, 1 1%, and 28%, respectively (Fig. 4D).
In the 18 patients with intrahepatic cholangiocarcinoma the overall 1-, 3-, and 5-year actuarial survival rates were 57%, 23%, and 23%, respectively. The median survival was 22 months. tumor survived for more than 25 months, and the median survival was 7 months. However, resection of the intrahepatic tumor resulted in a 5-year survival of 44%, and the median survival was 26 months (Fig. 4A). In the seven patients who were resected with negative microscopic margins, the 5-year actuarial survival was 57%.
Discussion
However, patients with resectable intrahepatic disease tend to have a better prognosis than do patients with extrahepatic cholangiocarcinoma. The median survival rate for resected intrahepatic cholangiocarcinoma has been reported to range from 9 to 30 months.'01'2"13,'5 In the current series, patients with resectable intrahepatic cholangiocarcinoma had a median survival rate of 22 months and a 5-year survival rate of 44%. Liver transplantation has been proposed as an alternative therapy for intrahepatic cholangiocarcinoma. Pichlmayr et al.'° report a median survival rate of 5.0 months in 18 patients treated with liver transplantation and a 12.8-month median survival rate for 32 patients treated with hepatic resection. Their data suggest that liver transplantation is not an effective therapy for intrahepatic cholangiocarcinoma, leaving hepatic resection is
the best treatment option.
Statistical Analysis
All data are presented as percentage of patients or mean ± standard error of the mean. Percentages were compared by chi square analysis, and means were analyzed by analysis of variance. Survival curves were constructed by the Kaplan-Meier technique and were compared by the log-rank test. Cox's proportional hazard survival analysis was used to determine which parameters affected survival. A p value < 0.05 was considered significant.
Survival
The 5-year actuarial survival for all 294 patients with cholangiocarcinoma was 10%, and the median survival was 14 months. No patient whose tumor was not resected has survived 5 years after surgery, and the median survival was 8 months.The overall 5-year actuarial survival rates for the intrahepatic, perihilar, and distal tumors were 23%, 6%, and 24%, respectively. Actuarial survival for intrahepatic, perihilar, and distal tumors stratified by resection versus palliation is presented in Figures 4A, B, and C. The 5-year survival rates for the resected intrahepatic, perihilar, and distal tumors were 44%, 1 1%, and 28%, respectively (Fig. 4D).
In the 18 patients with intrahepatic cholangiocarcinoma the overall 1-, 3-, and 5-year actuarial survival rates were 57%, 23%, and 23%, respectively. The median survival was 22 months. tumor survived for more than 25 months, and the median survival was 7 months. However, resection of the intrahepatic tumor resulted in a 5-year survival of 44%, and the median survival was 26 months (Fig. 4A). In the seven patients who were resected with negative microscopic margins, the 5-year actuarial survival was 57%.
Discussion
However, patients with resectable intrahepatic disease tend to have a better prognosis than do patients with extrahepatic cholangiocarcinoma. The median survival rate for resected intrahepatic cholangiocarcinoma has been reported to range from 9 to 30 months.'01'2"13,'5 In the current series, patients with resectable intrahepatic cholangiocarcinoma had a median survival rate of 22 months and a 5-year survival rate of 44%. Liver transplantation has been proposed as an alternative therapy for intrahepatic cholangiocarcinoma. Pichlmayr et al.'° report a median survival rate of 5.0 months in 18 patients treated with liver transplantation and a 12.8-month median survival rate for 32 patients treated with hepatic resection. Their data suggest that liver transplantation is not an effective therapy for intrahepatic cholangiocarcinoma, leaving hepatic resection is
the best treatment option.
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