Clinical Characteristics And Prognosis Analysis Of Advanced Cholan Giocarcinoma

Background and Objective:Cholangiocarcinoma usually diagnosed late with poor prognosis, more than 80 % of patients died in the first year after diagnosis. Radical surgery is the only method to cure the disease, which must be done at early stage. The patients still have high recurrence rate after surgery. Those unresectable patients can accept chemotherapy,transcatheter arterial chemoembolization (TACE) and (or) a palliative biliary decompression to improve their life quality. However at present there is no standard treatment for advanced cholangiocarcinoma. In this study we compare the efficiency of different treatments by analyzed clinical data of cholangiocarcinoma to provide evidences for improving prognosis.Methods : A retrospective analysis was made on 74 patients with cholangiocacinoma in the affiliated hospital of Dalian Medical University from September 2007 to September 2009. They have accepted palliative surgery, chemotherapy, TACE or BSC respectively, Progression-free survival time, median survival time, 1-year and 1.5-year survival rate were calculated. SPSS17.0 statistical software was used for the data processing . Kaplan–Meier, Log - rank inspection are used for statistical analysis , P < 0.05 was statistically significant different.Results:In 74 cases, Male 48 cases and female26. The median age is 64.6 years old. 50 cases (67.6%) with jaundice, including painless jaundice 31 cases (41.9%),19 cases(25.7%) has epigastrium unwell , 5 cases (7%) has other clinical manifestations. abnormal TB 65 cases(87.9%),abnormal ALP 64 cases (86.5%),abnormalγ-GT 64 cases (86.5%), abnormal ALT and AST 70 cases (94.6%), abnormal CEA 40 cases (44.8%), abnormal CA199 21 cases (88.9%), abnormal CEA and CA199 21 cases (28.4%), normal CEA and CA199 6 cases (8.1%). Median progression-free survival: palliative surgery is 7.0±1.8 months, chemotherapy is 5.0±2.2 months, TACE is 6.0±3.4 months and the BSC is 1.4±0.4 months. In the group of palliative surgery,the progression-free survival of chemotherapy after surgery is 11.0±0.0 months(p=0.01). No significant different were observed among each subgroup of chemotherapy and BSC. Median survival: palliative surgery is 11.0±1.9 months, chemotherapy is 13.9±1.3 months, TACE is 12.0±5.2 months and the BSC is 7.0±0.8 months. No significant different in subgroups. The one-year survival rates are 35.1% ,10% , 20%,and 0% respectively. The 1.5-year survival rates in the four groups are 0%.Conclusion: This study showed the patients accepting chemotherapy after palliative surgery had a better progression-free survival. Similar survival period were observed among palliative surgery, chemotherapy and TACE group. Therefore, chemotherapy for advanced cholangiocacinoma can avoid the damage of surgery and TACE. The BSC is used for those unresectable and those who are not suit for other therapy, although it can't change the progress of disease,it can improve the quality of life.