Preoperative evaluation with T-staging system for hilar cholangiocarcinoma

• Published in: World journal of gastroenterology : WJG 2007-11, Vol.13 (43), p.5754-5759
• Main Authors: Chen, Ru-Fu, Li, Zhi-Hua, Zhou, Jia-Jia, Wang, Jie, Chen, Ji-Sheng, Lin, Qing, Tang, Qi-Bing, Peng, Ning-Fu, Jiang, Zhi-Peng, Zhou, Quan-Bo
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Bile Duct Neoplasms - diagnosis; Bile Duct Neoplasms - pathology; Bile Duct Neoplasms - surgery; Bile Ducts, Intrahepatic - diagnostic imaging; Bile Ducts, Intrahepatic - pathology; Biopsy; Cholangiocarcinoma - diagnosis; Cholangiocarcinoma - pathology; Cholangiocarcinoma - surgery; Cholangiopancreatography, Magnetic Resonance; Female; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Neoplasm Staging - methods; Preoperative Care - methods; Rapid Communication; Ultrasonography, Doppler, Duplex; 临床医学; 外科手术; 存活率; 手术评估
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.v13.i43.5754

AIM： To investigate the clinical value of T-staging system in the preoperative assessment of hilar cholangiocarcinoma. METHODS： From March 1993 to January 2006, 85 patients who had cholangiocarcinoma diagnosed by operative tissue-biopsy were placed into one of three stages based on the new T-staging system, and it was evaluated the resectability and survival correlated with T-staging. RESULTS： The likelihood of resection and achieving tumor-free margin decreased progressively with increasing T stage （P 〈 0.05）. The cumulative 1-year survival rates of T1, T2 and T3 patients were 71.8%, 50.8% and 12.9% respectively, and the cumulative 3-year survival rate was 34.4%, 18.2% and 0% respectively; the survival of different stage patients differed markedly （P 〈 0.001）. Median survival in the hepatic resection group was greater than in the group that did not undergo hepatic resection （28 mo vs 18 mo; P 〈 0.05）. The overall accuracy for combined MRCP and color Doppler Ultrasonagraphy detecting disease was higher than that of combined using CT and color Doppler Ultrasonagraphy （91.4% vs 68%; P 〈 0.05 ）. And it was also higher in detecting port vein involvement （90% vs 54.5%; P 〈 0.05）.CONCLUSION： The proposed staging system for hilar cholangiocarcinoma can accurately predict resectability, the likelihood of metastatic disease, and survival. A concomitant partial hepatectomy would help to attain curative resection and the possibility of longterm survival. MRCP/MRA coupled with color Doppler UItrasonagraphy was necessary for preoperative evaluation of hilar cholangiocarcinoma.（OR = 2.46, 95% CI = 0.98-6.14）, and a significantly elevated risk of developing esophageal cancer among alcohol drinkers among alcohol drinkers （OR = 9.86, 95% CI = 3.10-31.38）. CONCLUSION： ADH2 and ALDH2 genotypes areassociated with esophageal cancer risk. ADH2＊1 allele and ALDH2＊2 allele carriers have a much higher risk of developing esophageal cancer, especially among alcohol drinkers.