Τίτλος:
Clinical presentation, diagnosis, and survival in cholangiocarcinoma: A prospective study
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
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 71 years (range 44–88). Thirty-four patients (73.9%) presented with painless jaundice. Median CA 19-9 value was 188 IU/L (range 1–49,138), with a level of <100 IU/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 ± 3.3 months. 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 ± 3.3 months, respectively, but the difference was not statistically significant (p = 0.115). Conclusion The diagnosis of CCA is difficult and often delayed. The outcome is generally poor. © 2016 Pan-Arab Association of Gastroenterology
Συγγραφείς:
Vasilieva, L.
Papadhimitriou, S.I.
Alexopoulou, A.
Kostopoulos, I.
Papiris, K.
Pavlidis, D.
Xinopoulos, D.
Romanos, A.
Dourakis, S.P.
Περιοδικό:
Arab Journal of Gastroenterology
Εκδότης:
Elsevier Ireland Ltd
Λέξεις-κλειδιά:
alkaline phosphatase; aspartate aminotransferase; bilirubin; CA 19-9 antigen; alkaline phosphatase; aspartate aminotransferase; bilirubin; CA 19-9 antigen, adult; aged; alkaline phosphatase blood level; Article; aspartate aminotransferase blood level; asymptomatic disease; bile duct carcinoma; biliary stent; biliary tract biopsy; biliary tract drainage; biliary tract endoscopy; bilirubin blood level; cancer cytodiagnosis; cancer diagnosis; cancer palliative therapy; cancer patient; cancer surgery; cancer survival; cancer therapy; cholangioscope; cholestasis; clinical article; clinical feature; conservative treatment; controlled clinical trial; controlled study; diagnostic test accuracy study; endoscopic retrograde cholangiopancreatography; female; follow up; human; human tissue; incidental finding; Klatskin tumor; laboratory diagnosis; liver resection; male; medical history; metal stent; obstructive jaundice; overall survival; pancreaticoduodenectomy; plastic stent; predictive value; primary biliary cirrhosis; priority journal; prospective study; protein blood level; quality of life; sensitivity and specificity; survival rate; tumor biopsy; Bile Duct Neoplasms; biopsy; blood; diagnostic imaging; Drainage; extrahepatic bile duct; intrahepatic bile duct; jaundice; Klatskin tumor; middle aged; palliative therapy; pathology; stenosis, occlusion and obstruction; very elderly, Adult; Aged; Aged, 80 and over; Alkaline Phosphatase; Aspartate Aminotransferases; Bile Duct Neoplasms; Bile Ducts, Extrahepatic; Bile Ducts, Intrahepatic; Bilirubin; Biopsy; CA-19-9 Antigen; Cholangiopancreatography, Endoscopic Retrograde; Constriction, Pathologic; Drainage; Female; Humans; Jaundice; Klatskin Tumor; Male; Middle Aged; Palliative Care; Prospective Studies; Survival Rate
DOI:
10.1016/j.ajg.2016.10.003
