Factors influencing survival of patients with nonresectable HILAR cholangiocarcinoma palliated endoscopically

Background. Endoscopic stent placement is considered as one of the best therapeutic option for palliation of patients (pts) with nonresecable hilar cholangiocarcinoma. At this date, there is no published study that provides detailed analyses of factors that has impact on survival of these pts palliated endoscopically. The aim of this retrospective study was to identify endoscopic and patient-related factors influencing the survival time of these pts.

Patients and Methods. We have identified 28 (male/female=16/12, mean age=80 [65–90] year) unresectable pts with hilar cholangiocarcinoma palliated endoscopically. All pts underwent unilateral placement of SEMS (n=16 [57%]) or a plastic stent of 10 F in diameter (n=12 [42%]). The type of the strictures were determined by Bismuth's classification (type II.=9 [32%], III.=8 [28%], IV.=11 [40%]). Pts were followed up until death, except one who is still alive. Such independent factors as age, gender, liver biochemistry, the type of stent, Bismuth-type of the stricture and the presence of sepsis were entered into Cox's-regression model to identify variables significantly associated to survival time. To assess acturial survival, significant variables were further analyzed by using the Kaplan-Meier method and the log rank test.

Results. The overall median survival was 7.0 (0.16–48) months. The stent type, Bismuth's type of the stricture and the presences of sepsis were those variables that had significant impact on survival. The median survival of pts palliated with SEMS and plastic stents were 8 (4.9–11) and 3 (0–6.3) months (p=0.012), respectively. The survival times according to the Bismuth's type were the followings: type II.=18 (0–38), III.=3 (0–6. 2), IV.=4 (1.4–6.5) months (p=0.001). The survival times of pts with and without sepsis were 2 (1.1–2.8) and 8 (5–10.6), respectively (p<0.001).

Conclusions. In our retrospective study, the most important predictive factor for survival of pts with nonresectable hilar cancer was the septic state. Sepsis positively correlated the higher Bismuth-types. Longer survival was independently influenced by lower Bismuth-type and the use of SEMS instead of plastic stent.