Resection for Hilar Cholangiocarcinoma: Analysis of Prognostic Factors and the Impact of Systemic Inflammation on Long-term Outcome

Abstract

Introduction: Resection for hilar cholangiocarcinoma is the single hope for long-term survival. Methods: Ninety patients underwent curative intent surgery for hilar cholangiocarcinoma between 1996 and 2012. The potential prognostic factors were assessed by univariate (Kaplan-Meier curves and log-rank test) and multivariate analyses (Cox proportional hazards model). Results: The median overall and disease-free survivals were 26 and 17 months, respectively. The multivariate analysis identified R0 resection (HR = 0. 03, 95 % CI 0-0. 19, p < 0. 001), caudate lobe invasion (HR = 6. 33, 95 % CI 1. 31-30. 46, p = 0. 021), adjuvant gemcitabine-based chemotherapy (HR = 0. 38, 95 % CI 0. 15-0. 94, p = 0. 037), and the neutrophil-to-lymphocyte ratio (HR = 0. 78, 95 % CI 0. 62-0. 98, p = 0. 036) as independent prognostic factors for disease-free survival. The independent prognostic factors for overall survival were R0 resection (HR = 0. 03, 95 % CI 0-0. 22, p < 0. 001), caudate lobe invasion (HR = 11. 75, 95 % CI 1. 65-83. 33, p = 0. 014), and adjuvant gemcitabine-based chemotherapy (HR = 0. 19, 95 % CI 0. 06-0. 56, p = 0. 003). Conclusions: The negative resection margin represents the most important prognostic factor. Adjuvant gemcitabine-based chemotherapy appears to benefit survival. The neutrophil-to-lymphocyte ratio may potentially be used to stratify patients for future clinical trials. © 2013 The Society for Surgery of the Alimentary Tract.