Novel Prognostic Scoring System after Surgery for Klatskin Tumor. Issue 1 (January 2013)

• Record Type: Journal Article
• Authors: Kaiser, Gernot M.; Paul, Andreas; Sgourakis, George; Molmenti, Ernesto P.; DechÊNe, Alexander; Trarbach, Tanja; Stuschke, Martin; Baba, Hideo A.; Gerken, Guido; Sotiropoulos, Georgios C.
• Is Part Of: American surgeon. Volume 79:Issue 1(2013)
• Page Start: 90
• Page End: 95
• Publication Date: 2013-01
• Subjects: Surgery -- Periodicals; Surgery -- United States -- Periodicals; 617.0973
• DOI: 10.1177/000313481307900136
• Languages: English
• ISSNs: 0003-1348

Abstract

Klatskin tumor is a rare hepatobiliary malignancy whose outcome and prognostic factors are not clearly documented. Between April 1998 and January 2007, 96 patients with hilar cholangiocarcinoma underwent resection. Data were collected prospectively. Thirty-one variables were evaluated for prognostic significance. There were 40 trisectionectomies, 40 hemihepatectomies, five central hepatectomies, and 11 biliary hilar resections. Thirty-seven (n = 37) patients required vascular reconstruction. There were 68 R0, 26 R1, and two R2 resections. Age ( P = 0.048), pT status ( P = 0.046), R class ( P = 0.034), and adjuvant chemoradiation ( P = 0.045) showed predictive significance by multivariate Cox proportional hazard regression analysis. A point scoring system was determined as follows: age younger than 62 years:age 62 years or older = 1:2 points; pT1:pT2 to 4 = 1:2 points; R0:R1/2 = 1:2 points; and chemoradiation yes:no = 1:2 points. The only model that reached statistical significance ( P = 0.0332) described the following three groups: score 6 or less; score = 7; and score = 8. Median survival for score 6 or less, score = 7, and score = 8 was 26.5, 12, and 2.2 months, respectively ( P = 0.032). The corresponding 1- and 3-year survival rates were 73 to 56 per cent, 52 to 38 per cent, and 17 to 0 per cent, respectively. We propose a scoring system predictive of long-term surgical outcome that could potentially improve patient selection for further postoperative oncologic treatment for Klatskin tumors.