The Resectability Assessment Of Hilar Cholangiocarcinoma And A Model Establishment For Prognosis Evaluation

Objective:to assess the respectability of hilar cholangiocarcinoma and analyze the related factors affecting prognosis. Meanwhile establishing a model for prognosis evaluation and providing the theoretical basis in order to further deepen understanding of hilar cholangiocarcinoma.Methods:154patients, who had been diagnosed hilar cholangiocarcinoma by imageological examination, were assessed the preoperative respectability. In retrospective analysis, prognostic and survival analysis were carried out and modified Jarnagin-Blumgart staging system was used to establish a model for prognosis evaluation.Results:By Bismuth-Corlette classification:23,27,21and4patients were undergone radical excision from type I to type IV. The radical resection rate was63.8%,57.4%,45.7%and16.0%. By TNM staging system:26,28,17and4patients were undergone radical excision from stage I to stage IV. By Jarnagin-Blumgart staging system:42,25and8patients were undergone radical excision from stage T1to stage T3. The radical resection rate was65.6%,47.2%and29.6%. The1-year,3-year and5-year survival rate of overall patients were65.9%,34.7%and21.4%, the median survival time was22months. The1-year,3-year and5-year survival rate of patients undergone curative treatment were74.3%,43.8%and33.5%, the median survival time was31months. The1-year,3-year and5-year survival rate of patients undergone palliative treatment were53.7%,25.7%and15.0%, the median survival time was14months. The odds ratio of patients who was less than65years old vs65years old and above was3.520. The odds ratio of curative treatment vs palliative treatment was2.141. The odds ratio of tumor size which was less than2cm vs2cm and above was1.608. The odds ratio of CA199negative vs positive was1.354. The odds ratio of total bilirubin which was less than34.2μmol/L vs34.2μmol/L and above was1.322. The odds ratio of tumor without metastasis vs metastasis was4.184. The odds ratio of the common bile duct and common hepatic artery lymph nodes without metastasis vs metastasis were1.231and2.125. The odds risk of postoperative recurrence of tumor poor differentiation, lymph node metastasis, vascular invasion and hepatic involvement were1.326times,2.328times,3.596times,4.406times and2.536respectively. In the prognosis evaluation model based on modified Jarnagin-Blumgart staging system, the accuracy of stage I for prognosis well, stage Ⅱ for prognosis moderate and stage Ⅲ for prognosis poor were57.6%,78.6%and73.5%respectively. The total survival predictive accuracy was69.5%.Conclusion:CA199, tumor location, portal vein invasion, hepatic involvement, lymph nodes involvement and tumor metastasis were related to respectability. The prognosis of hilar cholangiocarcinima was influenced by surgical options, tumor size, bilirubin, clinical stage and tumor metastasis. The number of lymph nodes dissection and regional lymph nodes involvement were also the prognostic factors. Palliative treatment, poor differentiation, lymph node metastasis, vascular invasion and hepatic involvement could increase the risk of postoperative recurrence. The predictive accuracy of prognosis evaluation model based on modified Jarnagin-Blumgart staging system was better than other clinical staging system, which could guide the surgical options and get an early prediction for the patients.