Clinical presentation, diagnosis, and survival in cholangiocarcinoma: A prospective study.
BACKGROUND AND STUDY AIMS: The diagnosis of cholangiocarcinoma (CCA) is difficult. The present study aimed to assess the clinical features, diagnosis, and survival in CCA.
PATIENTS AND METHODS: This 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.
RESULTS: The 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).
结果：发病中位年龄为71岁（范围44岁-88岁）。 34例患者（73.9％）表现为无痛性黄疸。 CA 19-9的中值为188IU / L（范围1-49,138），其中13例患者（28％）CA 19-9的水平为100IU / L。总胆红素的中值为11.9（0.6-36.3）mg / dL。患者肿瘤位于肝内3例（6.5％），肝门部（Klatskin）25例（54.3％），胆管下三分之一部位18例（39.1％）。确诊诊断方法中，细胞学阳性10例（21.7％），活检20例（43.5％），胆管镜检查5例（10.9％），影像学和临床依据11例（23.9％）。在36例患者中进行细胞学检查。其中10例为阳性，2例为“高度倾向”（敏感性33.3％）。22例（47.8％）接受外科手术切除，其余患者行姑息性胆道引流。整个CCA患者组的平均估计生存时间为21.5±3.3个月。接受手术切除的患者的生存期比接受姑息治疗的患者略长。平均估计生存率分别为26.2±4.2个月和17.1±3.3个月，但差异无统计学意义（p = 0.115）
CONCLUSION: The diagnosis of CCA is difficult and often delayed. The outcome is generally poor.
翻译：于廷廷 审校：张立超 侯森林