BACKGROUND/AIMS: Few studies have assessed the prognostic value of the primary tumor maximum standardized uptake value (SUVmax) measured by 2-[18F]-fluoro-2-deoxy-D-glucose PET-CT for patients with bile duct and gallbladder cancer. METHODS: A retrospective analysis of 61 patients with confirmed bile duct and gallbladder cancer who underwent FDG PET-CT in Kangbuk Samsung Medical Center (Seoul, Korea) from April 2008 to April 2011. Prognostic significance of SUVmax and other clinicopathological variables was assessed. RESULTS: Twenty-three patients were diagnosed as common bile duct cancer, 17 as hilar bile duct cancer, 12 as intrahepatic bile duct cancer, and nine as gallbladder cancer. In univariate analysis, diagnosis of intrahepatic cholangiocarcinoma and gallbladder cancer, mass forming type, poorly differentiated cell type, nonsurgical treatment, advanced American Joint Committee on Cancer (AJCC) staging and primary tumor SUVmax were significant predictors of poor overall survival. In multivariate analysis adjusted for age and sex, primary tumor SUVmax (hazard ratio [HR], 4.526; 95% CI, 1.813-11.299), advanced AJCC staging (HR, 4.843; 95% CI, 1.760-13.328), and nonsurgical treatment (HR, 6.029; 95% CI, 1.989-18.271) were independently associated with poor overall survival. CONCLUSIONS: Primary tumor SUVmax measured by FDG PET-CT is an independent and significant prognostic factor for overall survival in bile duct and gallbladder cancer.
Aged ; Bile Duct Neoplasms/*diagnosis/mortality/radionuclide imaging ; Cholangiocarcinoma/diagnosis/mortality/radionuclide imaging ; Female ; Fluorodeoxyglucose F18/diagnostic use/metabolism/standards ; Gallbladder Neoplasms/*diagnosis/mortality/radionuclide imaging ; Humans ; Kaplan-Meier Estimate ; Liver Neoplasms/diagnosis/mortality/radionuclide imaging ; Male ; Middle Aged ; Neoplasm Staging ; Positron-Emission Tomography/standards ; Prognosis ; Proportional Hazards Models ; Radiopharmaceuticals/diagnostic use/metabolism/standards ; Retrospective Studies ; Tomography, X-Ray Computed/standards

PURPOSE: Combined hepatocellular-cholangiocarcinoma (CHCC) is an uncommon form of cancer, and its clinicopathological features have rarely been reported in detail. This study was undertaken to evaluate the clinicopathological characteristics and prognostic factors of CHCC. MATERIALS AND METHODS: The clinicopathological features of patients diagnosed with CHCC at Severance Hospital between January 1996 and December 2007 were retrospectively studied by comparing them with the features of patients with hepatocellular carcinoma (HCC) or cholangiocarcinoma (CC) who had undergone a hepatic resection during the same period. RESULTS: Forty-three patients diagnosed with CHCC were included in this study (M : F=35 : 8, median age, 55 years). According to the parameters of the American Joint Committee on Cancer staging, there were 6 (14.0%), 9 (20.9%), 25 (58.1%), and 3 (7.0%) patients with stages I, II, III, and IV cancer, respectively. Thirty-two of the 43 patients underwent resection with curative intent. After resection, 27 patients (84.4%) had tumor recurrence during the follow-up period of 18 months (range: 6-106 months), and the median time to recurrence was 13 months. Overall median survival periods after hepatic resection of CHCC, HCC and CC were 34, 103 and 38.9 months, respectively (p<0.001). The median overall survival for all patients with CHCC was 21 months, and the 5-year survival rate was 18.1%. The presence of portal vein thrombosis and distant metastasis were independent prognostic factors of poor survival. CONCLUSION: Even after curative hepatic resection, the presence of a cholangiocellular component appeared to be a poor prognostic indicator in patients with primary liver cancer.
Adult ; Aged ; Carcinoma, Hepatocellular/mortality/*pathology ; Cholangiocarcinoma/mortality/*pathology ; Diagnosis, Differential ; Female ; Humans ; Kaplan-Meier Estimate ; Liver Neoplasms/mortality/*pathology ; Male ; Middle Aged ; Neoplasm Recurrence, Local/pathology ; Prognosis ; Republic of Korea/epidemiology ; Retrospective Studies

BACKGROUND/AIMS: This study was conducted to analyze the prognostic factors in patients with intrahepatic cholangiocarcinoma (ICC) who did not receive surgery. METHODS: Between August 1997 and November 2007, the medical records of 175 patients (mean age; 66 years, male/female 126/49), who were diagnosed as ICC, were reviewed retrospectively. RESULTS: Clonorchiasis and hepatolithiasis was found in 14.9%, and 6.3% of all patients, and no risk factors were identified in 77.8% of them. Surgical resection was performed in 29.1% (51 patients), chemotherapy +/- radiotherapy in 12.6% (22 patients), and palliative therapy in 58.3% (102 patients). The proportion of patients with stage I was 23.4% (41 patients). The prognostic factors in patients who did not receive surgery were alkaline phosphatase (ALP) and bilirubin levels by univariate and multivariate analysis. The median survival of patients with normal ALP and bilirubin levels was six months, whereas only one month in patients with elevated ALP and bilirubin levels (p<0.001). Tumor characteristics of patients with elevated bilirubin and ALP levels were infiltrative tumor, bile duct involvement, and very huge tumor. CONCLUSIONS: The prognostic factors of ICC in patients who did not receive surgery were ALP and bilirubin levels, but not lymph node metastasis.
Adult ; Aged ; Aged, 80 and over ; Alkaline Phosphatase/analysis ; Bile Duct Neoplasms/*diagnosis/mortality ; *Bile Ducts, Intrahepatic ; Bilirubin/analysis ; Cholangiocarcinoma/*diagnosis/mortality ; Female ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Risk Factors ; Survival Rate

BACKGROUND/AIMS: Combined hepatocellular and cholangiocarcinoma (HCC-CC) is a rare form of primary liver carcinoma which contains characteristics of both hepatocellular carcinoma and cholangiocarcinoma. The aim of this study was to evaluate the prognostic factors of combined HCC-CC after curative resection. METHODS: Between January 1987 and December 2005, pathologically confirmed combined HCC-CC patients who underwent curative resection at Seoul National University Hospital were evaluated. We reviewed the medical records and evaluated the time-to-recurrence (TTR), overall survival (OS) and prognostic factors of combined HCC-CC. RESULTS: A total of 31 patients were evaluated (M:F=27:4; median age, 61 years). According to the American Joint Committee on Cancer system, patients with stage I, II, III(A), III(B) and III(C) at the time of resection were 4, 16, 7, 2 and 2, respectively. Twenty six patients (83.9%) had tumor recurrence during the follow-up period and their median TTR was 5.7 months. Twenty one patients received additional treatment while 5 patients did not. As a result, median OS was 21.6 months and 3 year survival rate was 15.4%. In multivariate analysis, stage III than stage I or II at resection was an independent prognostic factor associated with shortened TTR (p<0.01). Older age (p=0.03), stage III(C) rather than stage I, II, III(A) at time of resection (p=0.02), and Child-Pugh B rather than A (p<0.01) were independent prognostic factors associated with shortened OS. CONCLUSIONS: Even after curative resections, patients with combined HCC-CC show poor prognosis with early recurrence and poor survival. However, surgical treatment should be warranted for relatively young patients in early stage with well preserved liver function.
Adult ; Aged ; Aged, 80 and over ; Bile Duct Neoplasms/*mortality/pathology/surgery ; *Bile Ducts, Intrahepatic ; Carcinoma, Hepatocellular/*mortality/pathology/surgery ; Cholangiocarcinoma/*mortality/pathology/surgery ; Female ; Hepatectomy ; Humans ; Liver Neoplasms/*mortality/pathology/surgery ; Male ; Middle Aged ; Neoplasm Recurrence, Local/*diagnosis ; Neoplasm Staging ; Predictive Value of Tests ; Prognosis ; Severity of Illness Index ; Survival Analysis ; Tomography, X-Ray Computed

BACKGROUNDS/AIMS: Although the survival rate after surgical resection of peripheral cholangiocarcinoma is low, surgical resection is only potentially curative therapy. The aim of this study is to evaluate clinicopathological factors affecting survival after surgical resection of peripheral cholangiocarcinoma. METHODS: Between February 1990 and December 2005, surgical intervention with curative intent was performed on 318 patients and 292 patients underwent resection. We retrospectively analyzed survival data of 318 patients and clinicopathological factors affecting survival by reviewing the medical record. RESULTS: Among the 292 cases of resection, curative resection with tumor-free margin (R0) has been resulted in 221 cases. The 1-, 3-, 5- and 10-year survival rate of R0 resection were 74.9, 46.9, 36.9 and 15.2%, respectively. The survival rate of patient undergoing R0 resection was significantly better than that of R1, R2 or nonresection. Multivariate analysis showed that curative resectability, macroscopic type of tumor and lymph node metastasis were statically significant independent prognostic factors. CONCLUSIONS: The survival after surgical resection of peripheral cholangiocarcinoma depends on curability of surgical resection, macroscopic type of tumor and status of lymph node. Particullary in R0 resection for intraductal growth type without lymph node metastasis, there is great chance for long-term survival. Surgical resection attaining tumor free margin should be attempted if liver function and general condition of patient are acceptable for hepatectomy.
Aged ; Bile Duct Neoplasms/diagnosis/*mortality/surgery ; *Bile Ducts, Intrahepatic ; Cholangiocarcinoma/diagnosis/*mortality/surgery ; Female ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Multivariate Analysis ; Predictive Value of Tests ; Retrospective Studies ; Survival Rate ; Treatment Outcome

PURPOSE: This study was conducted to evaluate the clinical significance of choledochoscopy in biliary tract diseases. METHODS: We conducted a retrospective study of 291 patients who received choledochoscopy from October 1993 to December 1999. The indications of choledochoscopy were 259 cases of bile duct stones and 32 cases of benign and malignant biliary diseases: Klatskin tumor (n=10), intrahepatic cholangiocarcinoma (n=8), common bile duct cancer (n=6), hepatocellular carcinoma with bile duct invasion (n=2), and benign biliary stricture (n=6). The purpose of the choledochoscopy was 1) removal of bile duct stones, 2) differentiation between benign and malignant biliary diseases and 3) preoperative assessment of the extent and resectability of bile duct carcinoma. RESULTS: The success rate of complete stone removal was 80.1%, and the rate of recurrent biliary stones after a mean follow-up period of 24 months was 13.1%. The most common cause of a failure to remove the stones was biliary stricture. Differentiating between benign and malignant lesions, and the preoperative assessment of the extent and resectability of a bile duct carcinoma were accomplished by choledochoscopic observation followed by biopsy. The sensitivity in the diagnosis of malignant biliary diseases was 87%. The morbidity and mortality rates of choledochoscopy were 3.4% and 0%, respectively. With the exception of bile peritonitis due to tract rupture, any complications, such as cholangitis, bleeding, and pain, were conservatively managed. CONCLUSION: Our experience shows that choledochoscopyhas an important role in the diagnosis and therapy for benign and malignant biliary diseases and can be applied if indicated.
Bile ; Bile Ducts ; Biliary Tract Diseases* ; Biliary Tract* ; Biopsy ; Carcinoma, Hepatocellular ; Cholangiocarcinoma ; Cholangitis ; Common Bile Duct ; Constriction, Pathologic ; Diagnosis ; Follow-Up Studies ; Hemorrhage ; Humans ; Klatskin's Tumor ; Mortality ; Peritonitis ; Retrospective Studies ; Rupture