Ann Hepatobiliary Pancreat Surg.  2023 May;27(2):151-157. 10.14701/ahbps.22-090.

Survival analysis of extrahepatic cholangiocarcinoma based on surveillance, epidemiology, and end results database

• Ali H
• Zweigle J
• Patel P
• Tedder B
• Khan R
• Agrawal S

• KMID: 2542578
• DOI: http://doi.org/10.14701/ahbps.22-090

Abstract

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.

Keyword

Cholangiocarcinoma; Lymph nodes; Survival analysis; Bile ducts; extrahepatic; Bile duct neoplasms

Figure

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  Fig. 1 Kaplan–Meier curves for survival based on therapy (p < 0.01).

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  Fig. 2 Kaplan–Meier curves for survival based on lymph node resection during surgery (p < 0.01).

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  Fig. 3 Kaplan–Meier curves for survival based on perihilar cholangiocarcinomas (CCA) or distal CCA (p < 0.01).

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