Introduction The incidence and mortality of Intrahepatic bile duct cholangiocarcinoma (CCA) has risen worldwide over the past few decades. Over the last four decades, an exponential rise in the age-standardised mortality rate of CCA has been recorded in England and Wales. We examined the factors affecting survival from CCA at a regional hepato-biliary centre.
Method We retrospectively reviewed 340 patients with confirmed CCA to evaluate the factors affecting survival over a period of six years (2009–2014). The hospital integrated data base was used for clinical, radiological, histological and endoscopic details. Overall survival by modality of treatment was examined by Kaplan-Meier log rank test. Factors contributing to mortality were assessed by Cox proportional hazards.
Results There was a female preponderance of CCA (n = 174, 51.2%), histology being the most prevalent mode of diagnosis (n = 154, 45.3%) and palliative biliary stenting most utilised treatment (n = 171, 50.3%). Intrahepatic CCA had the largest tumour diameter versus extrahepatic CCA (median: 6.2 cm vs 3.0 cm, p= <0.0001). Overall median survival was 8 months (range 7–11). The median survival for those treated with chemotherapy, biliary stent and best supportive care were 16 (11–18), 5 (4–6) and 4 (2–7) months, respectively. 5 year survival post resection was 80%. Surgical resection and chemotherapy were associated with improved survival (HR: 0.13; 95% CI: 0.06–0.28, p < 0.0001) and (HR: 0.33; 95% CI: 0.17–0.60, p = 0.0003) respectively, whereas the presence of biliary calculi at diagnosis conferred a negative impact on survival (HR: 1.83; 95% CI: 1.19–2.81, p = 0.006). Presence of biliary calculi was a significant independent predictor of survival in patients with hilar CCA.
Conclusion Similar to experience elsewhere, we observed that surgical resection and chemotherapy offered survival benefit to CCA patients. The association of increased mortality in presence of biliary calculi prompts further prospective investigation of the possibility that the diagnosis of stone disease delays recognition of coexisting bile duct tumours.
Disclosure of interest None Declared.
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