A Retrospective Analysis Of Clinical Features,Treatment And Prognosis In Patients With Cholangiocarcinoma

Cholangiocarcinoma(CCA)is a rare,highly invasive primary cholangiocarcinoma which was difficultly diagnosed early and been with poor prognosis.In the recent decade,with the increasing of cholangiocarcinoma in the world,people gradually pay attention to the exploration of the pathogenesis of the disease and the improvement of clinical diagnosis and treatment.This study is carried out to make a retrospective review on the clinical features,treatment and prognosis of patients with cholangiocarcinoma in our hospital,which aims to reveal this disease further and improve the early diagnosis,treatment procedures and the prognosis.This study enrolled 36 patients with cholangiocarcinoma in Zhongshan hospital affiliated to Xiamen University from January 2013 to June 2018,including 17 cases of intrahepatic cholangiocarcinoma,13 cases of hilar cholangiocarcinoma and 6 cases of distal cholangiocarcinoma(extrahepatic cholangiocarcinoma),as well as 50 cases of examiner without tumor.We collected the demographic information,laboratory and imaging results,treatment methods,survival time after treatment and so on,SPSS statistical software was used for further analysis.The results showed that:1)Intrahepatic,hilar and distal cholangiocarcinoma accounted for 47.2%,36.1%and 16.7%of cholangiocarcinoma respectively.Cholelithiasis is an independent risk factor both for intrahepatic and hilar cholangiocarcinoma,however there is no significant risk factor found in distal cholangiocarcinoma.Three groups of cholangiocarcinoma with cholelithiasis have similar survival time after surgery.2)The clinical manifestations of cholangiocarcinoma include jaundice,abdominal pain,itchy skin,fever,weight loss,ascites;intrahepatic cholangiocarcinoma with abdominal pain mainly,but hilar and distal cholangiocarcinoma with jaundice mainly.3)Child-Pugh scores in patients with cholangiocarcinoma includes grade A and grade B,in which intrahepatic cholangiocarcinoma is mainly grade A,and hilar and distal cholangiocarcinoma is grade B.Hilar cholangiocarcinoma has the highest scores in three on end-stage liver disease model(MELD).Endoscopic retrograde cholangiopancreatography(ERCP)treatment could lower total bilirubin in the hilar and distal cholangiocarcinoma,but could not improve Child-Pugh and MELD score.4)The main treatment of cholangiocarcinoma in each group is surgery,which also includes ERCP,percutaneous transhepatic biliary drainage(PTCD),radiotherapy,chemotherapy,transcatheter arterial chemoembolization(TACE),radiofrequency ablation(RFA);5)Survival time of intrahepatic cholangiocarcinoma in surgery is longer than chemotherapy,but there is no difference between surgery or chemotherapy and combination therapies,as well as among the different combination therapies each other.For hilar and distal cholangiocarcinoma,there is no difference in survival time between surgery and ERCP or combination therapies,ERCP and combination therapies,as well as different combination therapies each other.Furthermore,in terms of different anatomical locations of cholangiocarcinoma,there was no significant difference in survival time among surgery alone,ERCP combined surgery,and surgery combined with postoperative radiotherapy.In summary,the conclusions of this retrospective study are:1)cholelithiasis is an independent risk factor for cholangiocarcinoma,and may have a similar impact on prognostic among three groups of cholangiocarcinoma.2)Abdominal pain is a major clinical manifestation in the intrahepatic cholangiocarcinoma,but jaundice in the extrahepatic cholangiocarcinoma.3)Compared with intrahepatic cholangiocarcinoma,extrahepatic cholangiocarcinoma may have poorer liver function reservation,and a higher risk of liver failure and death.ERCP may improve jaundice in patients with extrahepatic cholangiocarcinoma,but may not decrease the risk of liver failure and death.4)Surgery may bring a better prognosis than systemic chemotherapy in intrahepatic cholangiocarcinoma,but surgery may bring similar prognosis to other combined treatments.Extrahepatic cholangiocarcinoma may have the similar prognosis after the different therapies.There may be similar prognosis among the three groups after similar treatment respectively.