The Assessment Of Clinlical Treatment Outcome Of Advanced Hilar Cholangiocarcinoma (Stage Ⅲ-Ⅳ)

Objective:Undoubtly,the operation is the best choice of hilar cholangiocarcinoma(HCCA)in the early stage.However,due to the complexity,difficulty of the surgery of advanced HCCA,most of them preferred underwent PTCD or ENBD drainage in order to prolong life,improve the quality of life.The purpose of this study was to analyze the factors that influence the survival of the advanced hilar cholangiocarcinoma,and to establish the evaluation model,and to provide sufficiently valuable evidences for the treatment.Methods:A total of 176 consecutive patients with HCCA at late stage(Ⅲ and Ⅳ)were treated at our hospital between January 2011 and December 2013.They were retrospectively analysed based on the clinical variables,Bismuth-Corlette types,radicality of operation and survival rates.Single factor analysis was performed to determine the prognostic factors,and Cox regression model for multivariate analysis was applied to understand the independent factors influencing the survival rate.SPSS version 17.0 was used to perform all statistical analyses.The Cox regression model(Hazard ratiomodel)was employed to perform multi-factor analysis.Significance was set as no more than 0.05.Results:Univariate analysis showed that age(P = 0.001),level of total bilirubin(P = 0.003),ALT(P = 0.004)and CEA(P = 0.001),Bismuth type(P =0.041),treatment modalities(P<0.001)and hepatic artery invasion(P = 0.011)were significantly associated with the overall survival of HCCA patients at advanced stage.Cox proportional hazard model analysis showed level of total bilirubin(P = 0.009,HR = 2.00),hepatic artery invasion(P = 0.014,HR = 1.84)and treatment modalities(P = 0.020,HR = 0.76)were identified as independent predictors.A Cox model was built to predict the probability of death:PI=0.692×level of total bilirubin + 0.609×hepatic artery invasion-0.274×treatment modalities.Subclass analyses showed In radical resection group,patients with high level of total bilirubin had significantly poorer prognosis than those with low level of total bilirubin(MST,9.7 months vs.26.7months,P = 0.005),while patients with hepatic artery invasion had the same prognosis as patients without hepatic artery invasion(MST,19.8 months vs.20.7 months,P = 0.297).Conversely,for patients received palliative treatment(including palliative resection,ERCP and PTCD),the level of total bilirubin was not a predictor,while patients with hepatic artery invasion had significantly poorer prognosis than those without hepatic artery invasion(P>0.05).Conclusion:Patients’age,serum total bilirubin level,hepatic artery invasion were the most important factors affecting the survival of patients.Surgery is still the best treatment for advanced hilar cholangiocarcinoma.