| dc.description.abstracteng | Background: Cholangiocarcinoma (CCC) is a rare malignant disease of the gastrointestinal tract. As the tumor is often diagnosed in advanced stages the resection rate and the survival time is low. For these patients a palliative treatment is the only option to sustain the quality of life and to prolong survival. The focus of this retrospective study was the various curative and palliative therapeutic regimes and the respective survival times.
Methods: We retrospectively analysed 105 patients who have been treated in the years from 2000 to 2010 at the University Medical Center of Goettingen due to CCC. 47 patients underwent surgery with curative intent. 56 patients could be treated only palliative due to the advanced stage of CCC. Survival times between the two treatment options were compared by Kaplan-Meier analysis. To determine factors that affect survival time we used Cox proportional hazard analysis.
Results: 47 patients (47/105) underwent surgery with curative intent. In 83% of patients (39/47) the tumor could be removed from healthy tissue. The median recurrence free survival was eight months. 56 patients (56/105) could be treated only palliative due to the advanced stage. The median survival of curative operated patients was 22 months, the median survival of the palliative treated patients however 5,5 months. This results in a significant survival benefit of curative operated against the palliative treated patients (p<0,01). The 1-, 3- and 5-year survival of the curative operated patients was 79,8% (95% CI: 68-91,6%), 41,2% (95% CI: 26,1-56,3%) and 21,6% (95% CI: 34,8-8,4%), whereas the palliative treated patients showed results of 25,9% (95% CI: 14,2-37,6%), 2,5% (95% CI: -2,2-7,6%) and 2,5% (95% CI: -2,2-7,6%). Patients with palliative chemotherapy showed a significant improvement of survival time over palliative patients without chemotherapy. The 1-year survival and the median survival time with chemotherapy was 33,3% (95% CI: 17,9-48,7%) and nine months, though without chemotherapy 6,3% (95% CI: -5,6-18,2%) and two months. Univariate analysis showed that lymph node metastasis, distant metastasis, tumor spread and tumor localization are associated with a poorer prognosis.
Conclusion: In summary, the prognosis of CCC is very poor. The only possibility of cure is the curative R0 resection. However, this is not an option for the majority of patients due to the frequently advanced tumor stage at the time of diagnosis. In this case the palliative treatment comes into the foreground. Due to the significant survival benefit of primary palliative patients treated with chemotherapy compared with the primary palliative patients not receiving chemotherapy, a chemotherapeutic treatment should be sought in patients who cannot undergo curative surgery because of an advanced tumor stage. | de |