Prognostic factors and long-term outcomes of hilar cholangiocarcinoma: A single-institution experience in China

AIM: To evaluate the prognostic factors of hilar cholangiocarcinoma in a large series of patients in a single institution. METHODS: Eight hundred and fourteen patients with a diagnosis of hilar cholangiocarcinoma that were evaluated and treated between 1990 and 2014, of which 381 patients underwent curative surgery, were included in this study. Potential factors associated with overall survival (OS) and disease-free survival (DFS) were evaluated by univariate and multivariate analyses. RESULTS: Curative surgery provided the best long-term survival with a median OS of 26.3 mo. The median DFS was 18.1 mo. Multivariate analysis showed that patients with tumor size > 3 cm [hazard ratio (HR) = 1.482, 95% CI: 1.127-1.949; P = 0.005], positive nodal disease (HR = 1.701, 95% CI: 1.346-2.149; P < 0.001), poor differentiation (HR = 2.535, 95% CI: 1.839-3.493; P < 0.001), vascular invasion (HR = 1.542, 95% CI: 1.082-2.197; P = 0.017), and positive margins (HR = 1.798, 95% CI: 1.314-2.461; P < 0.001) had poor OS outcome. The independent factors for DFS were positive nodal disease (HR = 3.383, 95% CI: 2.633-4.348; P < 0.001), poor differentiation (HR = 2.774, 95% CI: 2.012-3.823; P < 0.001), vascular invasion (HR = 2.136, 95% CI: 1.658-3.236; P < 0.001), and positive margins (HR = 1.835, 95% CI: 1.256-2.679; P < 0.001). Multiple logistic regression analysis showed that caudate lobectomy [odds ratio (OR) = 9.771, 95% CI: 4.672-20.433; P < 0.001], tumor diameter (OR = 3.772, 95% CI: 1.914-7.434; P < 0.001), surgical procedures (OR = 10.236, 95% CI: 4.738-22.116; P < 0.001), American Joint Committee On Cancer T stage (OR = 2.010, 95% CI: 1.043-3.870; P = 0.037), and vascular invasion (OR = 2.278, 95% CI: 0.997-5.207; P = 0.051) were independently associated with tumor-free margin, and surgical procedures could indirectly affect survival outcome by influencing the tumor resection margin. CONCLUSION: Tumor margin, tumor differentiation, vascular invasion, and lymph node status were independent factors for OS and DFS. Surgical procedures can indirectly affect survival outcome by influencing the tumor resection margin.