Clinical presentation, diagnosis, and survival in cholangiocarcinoma: A prospective study

Publication date: Available online 30 November 2016
Source:Arab Journal of Gastroenterology
Author(s): Larisa Vasilieva, Stefanos I. Papadhimitriou, Alexandra Alexopoulou, Ioannis Kostopoulos, Konstantinos Papiris, Dimitrios Pavlidis, Dimitrios Xinopoulos, Andreas Romanos, Spyridon P. Dourakis
Background and study aimsThe diagnosis of cholangiocarcinoma (CCA) is difficult. The present study aimed to assess the clinical features, diagnosis, and survival in CCA.Patients and methodsThis is a prospective study on 46 patients with CCA who underwent endoscopic retrograde cholangiopancreatography (ERCP) or surgical resection and 20 controls with a clinical and ERCP suspicion for CCA in whom surgical biopsy and/or 4-year follow-up showed a benign biliary stricture.ResultsThe median age at presentation was 71years (range 44–88). Thirty-four patients (73.9%) presented with painless jaundice. Median CA 19-9 value was 188IU/L (range 1–49,138), with a level of <100IU/L in 13 patients (28%). Total bilirubin was 11.9 (0.6–36.3)mg/dL. The tumour was intrahepatic in 3 (6.5%), hilar (Klatskin) in 25 (54.3%), and located in the lower third of the bile duct in 18 (39.1%) patients. The diagnosis was confirmed by positive cytology in 10 (21.7%), biopsy in 20 (43.5%), cholangioscopy in five (10.9%), and imaging and clinical grounds in 11 (23.9%) patients. Cytology was feasible in 36 patients; it was positive in 10 and "highly indicative" in two patients (33.3% sensitivity). Twenty-two patients (47.8%) were treated by surgical resection, and the rest were offered palliative biliary drainage. Mean estimated survival for the entire group of CCA patients was 21.5±3.3months. Survival was slightly longer in patients who underwent surgical resection than those who had palliative treatment; the estimated mean survival rates were 26.2±4.2 vs. 17.1±3.3months, respectively, but the difference was not statistically significant (p=0.115).ConclusionThe diagnosis of CCA is difficult and often delayed. The outcome is generally poor.



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