Comorbidity negatively influences prognosis in patients with extrahepatic cholangiocarcinoma

AIM： To study the outcome and prognostic factors in a series of patients with extrahepatic cholangiocarcinoma and determine the impact of comorbidity on survival. METHODS： A retrospective analysis of 68 patients with extrahepatic cholangiocarcinoma （perihilar, n = 37; distal, n = 31） seen at a single tertiary-care institution during the period 1999-2003 was performed. Data on presentation, management, and outcome were assessed by chart review. Pathologic confirmation was obtained in 37 cases （54.4%）. Comorbidity was evaluated by using the Charlson comorbidity index （CCI）. RESULTS： Mean age at diagnosis was 73.4 ± 11.5 years. Jaundice was the most common symptom presented （86.8%）. Median CCI score was 1 （range, 0 to 4）. Nineteen patients （27.9%） underwent tumor resection. Palliative biliary drainage was performed in 39 patients （57.4%）, and 6 patients （8.8%） received only best supportive care. Tumor-free margin status （R0） was achieved in 15 cases （78.9% of resection group）. Baseline serum carbohydrate antigen 19-9 （CA 19-9） level was revealed to be an independent predictor of surgical treatment （P = 0.026）. Overall median survival was 3.1 ＋ 0.9 mo, with 1- and 2-year survival rates of 21% and 7%, respectively. In the univariate analysis, tumor resection, CCI score, and serum CA 19-9 levels correlated significantly with outcome. In the multivariate analysis, only resection （HR 0.10; 95% CI, 0.02-0.51, P = 0.005） and a CCI score ≥ 2 （HR 3.36; 95% CI, 1.0-10.9, P = 0.045） were found to independently predict survival. CONCLUSION： Tumor resection and comorbidity emerged as significant prognostic variables in extra- hepatic cholangiocarcinoma. Comorbidity evaluation instruments should be applied in the clinical management of such patients.