Prognostic Influence For Hilar Cholangiocarcinoma And Comparisons Of Prognostic Values Of Mayo Staging And TNM Staging Systems

Objecive The study was designed to discuss the ability of prognostic value of mayo staging system for patients with hilar cholangiocarcinoma.To compare with current AJCC 7th TNM staging system.Methods To make retrospective analysis of clinical data of 335 patiens with hilar cholangiocarcinoma,which can be used to Mayo staging system,received and cured by Affiliated Hospital of Qingdao University from February1,2004 to January 1,2013.All patients were followe-up until September 30,2016.According to a variety of clinical data of the patients diagnosed with hilar cholangiocarcinoma befor treatment,the study obtained statistically significant factors by the using of Kaplan-Meier method and log-rank test for univariate analysis.Make analysis of independent prognostic factors by Cox analysis method.Correlation analysis was carried out on the two staging system and the multiple comparisons did within system to evaluate degree of differentiation and single trend of staging system.The ROC curves were used for each single staging system trend analysis,and comparison of their curve area to determine prognosis prediction ability for patients with hilar cholangiocarcinoma.Results By September 30,2016,a total of 283 patients died,40 patients without follow-up data or refused to participate in this study,12 patients were censored(censored proportion of 4.1%).The median survival time was12.4 months,1-,2-and 3-year survival rates were(51.9±2.9)%,(21.1±2.5)%,(12.6±1.9)%.Accordding to Kaplan-Meier analysis and log-rank test,that the maximum diameter of tumor >3cm(P<0.001),albumin level?35g/L(P<0.001),tumor metastasis(P<0.001),lymph node metastasis(P<0.001),treatment(P<0.001),prealbumin level ?200g/L(P=0.015),the grade of ECOG performance status(P<0.001),Bismuth-Corlete typing system(P<0.001),CA19-9 level ?1000U/ml(P=0.003),and Vascular encasement(P=0.037)have influence on the prognosis of patients.COX proportional hazard analysis showed that the maximum diameter of tumor(P<0.001),Bismuth-Corlete typing system,tumor metastasis,different treatment methods,the grade of ECOG performance status and albumin were independent prognostic indicators of survival.According to the Kaplan-Meier survival curve and the log-rank test,it was found that both staging systems were correlated with the survival time of the patients(P <0.001),the later stage was,the worse the prognosis was.Through the internal comparison of the two phases,it was found that the heterogeneity between the stages of the Mayo staging system was very good,which was superior to the TNM staging system.The single trend analysis of the prognosis of the two systems was carriedout.It was found that the area under the ROC curve of Mayo staging system(AUC=0.587)was the largest and better than the TNM staging(AUC=0.501).Conclusion Based on nonoperative information,mayo staging system has strong power to classify patients into four prognostic stages.The predictive value of mayo staging system is superior to TNM staging system.From mayo staging system,maximum diameter of tumor >3cm,tumor metastasis and the grade of ECOG performance status were independent prognostic indicators of survival.But it would be needed some further researches whether CA19-9 level ?1000U/ml could be used as an evaluation index of the 3 period or not.Radical resection and preoperative albumin level can significantly improve the survival of patients.