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KMID : 1143920230270020151
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Annals of Hepato-Biliary-Pancreatic Surgery
2023 Volume.27 No. 2 p.151 ~ p.157
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Survival analysis of extrahepatic cholangiocarcinoma based on surveillance, epidemiology, and end results database
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Hassam Ali
Joshua Zweigle
Pratik Patel
Brandon Tedder
Rafeh Khan
Saurabh Agrawal
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Abstract
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Backgrounds/Aims: Cholangiocarcinoma (CCA) can be classified as intrahepatic CCA or extrahepatic CCA (eCCA). We intended to analyze and reports the survival outcomes for eCCA.
Methods: Surveillance, epidemiology, and end results (SEER) registry, site recode C24.0, was used to select cases of eCCA from 2000 to 2018. Patients with incomplete data or ages <18 years were excluded.
Results: Male (52.69%) and White race (77.99%) predominated. Compared with 2000?2006, survival increased in 2013 (adjusted hazard ratio [HRadj]: 0.68, 95% confidence interval [CI] 0.58?0.70; p < 0.01). Surgery with chemoradiotherapy (HRadj: 0.69, 95% CI 0.60?0.7; p < 0.01) and surgery with chemotherapy (HRadj: 0.72, 95% CI 0.62?0.83; p < 0.01) improved survival over surgery alone. Compared with surgery without lymph node (LN) removal, surgery of four or more regional LN reduced the risk of death by 58% (HRadj: 0.42, 95% CI 0.36?0.51; p < 0.01). Compared with patients without surgery, patients who underwent bile duct excision (HRadj: 0.82, 95% CI 0.72?0.94; p < 0.01), simple or extended lobectomy (HRadj: 0.85, 95% CI 0.75?0.95; p = 0.009), and hepatectomy (HRadj: 0.80, 95% CI 0.72?0.88; p < 0.01) significantly improved survival. Patients with distal CCA had a 17% higher survival than perihilar CCA (HRadj: 0.83, 95% CI 0.74?0.92; p < 0.01) and LN dissection was equally beneficial for both subgroups (p < 0.01).
Conclusions: Surgery with chemoradiotherapy has a proven increase in the 5-year survival of the eCCA. LN resection, bile duct excision, lobectomy, and hepatectomy have better outcomes.
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KEYWORD
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Cholangiocarcinoma, Lymph nodes, Survival analysis, Bile ducts, extrahepatic, Bile duct neoplasms
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