Novel prognostic scoring system after surgery for klatskin tumor

Abstract

Klatskin tumor is a rare hepatobiliary malignancy whose outcome and prognostic factors are not clearly documented. BetweenApril 1998 and January 2007, 96 patientswith hilar cholangiocarcinoma underwent resection. Data were collected prospectively. Thirty-one variables were evaluated for prognostic significance. There were 40 trisectionectomies, 40 hemihepatectomies, five central hepatectomies, and 11 biliary hilar resections. Thirty-seven (n 5 37) patients required vascular reconstruction. There were 68 R0, 26 R1, and two R2 resections. Age (P 5 0.048), pT status (P 5 0.046), R class (P5 0.034), and adjuvant chemoradiation (P5 0.045) showed predictive significance by multivariate Cox proportional hazard regression analysis. A point scoring system was determined as follows: age younger than 62 years:age 62 years or older 5 1:2 points; pT1:pT2 to 4 5 1:2 points; R0:R1/2 5 1:2 points; and chemoradiation yes:no 5 1:2 points. The only model that reached statistical significance (P 5 0.0332) described the following three groups: score 6 or less; score 5 7; and score 5 8. Median survival for score 6 or less, score 5 7, and score 5 8 was 26.5, 12, and 2.2 months, respectively (P 5 0.032). The corresponding 1- and 3-year survival rates were 73 to 56 per cent, 52 to 38 per cent, and 17 to 0 per cent, respectively. We propose a scoring system predictive of long-term surgical outcome that could potentially improve patient selection for further postoperative oncologic treatment for Klatskin tumors. Copyright Southeastern Surgical Congress. All rights reserved.