Survival analysis of extrahepatic cholangiocarcinoma based on surveillance, epidemiology, and end results database

Abstract

Backgrounds/Aims: Cholangiocarcinoma (CCA) can be classified as intrahepatic CCA or extrahepatic CCA (eCCA). We intended to analyze and reports the survival outcomes for eCCA. Methods: Surveillance, epidemiology, and end results (SEER) registry, site recode C24.0, was used to select cases of eCCA from 2000 to 2018. Patients with incomplete data or ages <18 years were excluded. Results: Male (52.69%) and White race (77.99%) predominated. Compared with 2000-2006, survival increased in 2013 (adjusted hazard ratio [HRadj]: 0.68, 95% confidence interval [CI] 0.58-0.70; p < 0.01). Surgery with chemoradiotherapy (HRadj: 0.69, 95% CI 0.60-0.7; p < 0.01) and surgery with chemotherapy (HRadj: 0.72, 95% CI 0.62-0.83; p < 0.01) improved survival over surgery alone. Compared with surgery without lymph node (LN) removal, surgery of four or more regional LN reduced the risk of death by 58% (HRadj: 0.42, 95% CI 0.36-0.51; p < 0.01). Compared with patients without surgery, patients who underwent bile duct excision (HRadj: 0.82, 95% CI 0.72-0.94; p < 0.01), simple or extended lobectomy (HRadj: 0.85, 95% CI 0.75-0.95; p = 0.009), and hepatectomy (HRadj: 0.80, 95% CI 0.72-0.88; p < 0.01) significantly improved survival. Patients with distal CCA had a 17% higher survival than perihilar CCA (HRadj: 0.83, 95% CI 0.74-0.92; p < 0.01) and LN dissection was equally beneficial for both subgroups (p < 0.01). Conclusions: Surgery with chemoradiotherapy has a proven increase in the 5-year survival of the eCCA. LN resection, bile duct excision, lobectomy, and hepatectomy have better outcomes.

Current Standards, Multidisciplinary Approaches, and Future Directions in the Management of Extrahepatic Cholangiocarcinoma

“…Conditions predisposing to eCCA include chronic pancreatitis, cholangitis, and choledocholithiasis [ 5 , 8 ] with the estimated incidence of around 1.02 cases per 100,000 annually [ 9 ]. The prognosis for eCCA remains poor with 5-year survival estimated at 11% (localized and regional: 18%; distant: 2%) and surgery remains the only curative option in non-metastatic eCCA [ 10 , 11 ]. Patients with risk factors such as higher T-stage ( p < 0.001, locoregional disease [LRD]; p = 0.005, distant disease [DD] in T1a vs T1b-T4 disease) and the presence of lymphovascular invasion ( p = 0.004, LRD; p = 0.01, DD) or perineural invasion ( p = 0.04, LRD; p = 0.006, DD) are at risk for local and distant recurrence following definitive resection [ 12 ].…”

An overview of extrahepatic cholangiocarcinoma: from here to where?

“…In addition, pCCA and dCCA have different prognoses and distinctive epidemiological trends. Surveillance, Epidemiology, and End Results (SEER) database have shown better survival in dCCA when compared with pCCA from 2000 to 2018 ( 14 ). Regarding dCCA, a recent Swedish cohort study disclosed that incidence rates elevated principally among those patients aged more than 55 during the consecutive calendar periods.…”