Prognostic factors of distal cholangiocarcinoma after curative surgery: a series of 84 cases.

Background/aims: The aim of this study was to identify useful prognostic factors for patients with distal cholangiocarcinoma.

Methodology: The records of 84 patients with distal cholangiocarcinoma undergoing pancreatoduodenectomy were retrospectively reviewed. Potential clinicopathological prognostic factors that may affect survival were examined by univariate and multivariate analyses.

Results: There were two patients died within 30 days of surgery. Overall survival rates were 69.51%, 42.68%, and 36.59% for 1, 3 and 5 years, respectively (median survival time, 32.74 months). Univariate analysis found that alanine aminotransferase/aspartate aminotransferase (AST/ALT) ratio less than and equal to 2, serum bilirubin less than and equal to 171 micromol/L, CA19-9 level less than 150 U/L, tumor size less than 2 cm, absent neural invasion, and absent lymph node involvement were associated with higher survival rate (p < 0.05). Furthermore, multivariate analysis found that AST/ALT ratio more than 2, present lymph node involvement and present neural invasion were the independent risk factors of poor survival (p < 0.01).

Conclusions: These results suggest that not only the well-known lymph node involvement, but also neural invasion and AST/ALT ratio more than 2 might be useful prognostic factors for long-term survival in distal cholangiocarcinoma.