Prognostic Factors for Survival in Patients With Cholangiocarcinoma

BACKGROUND

Cholangiocarcinoma (CCA) is a highly aggressive neoplasia and is considered the second most common primary liver cancer (1). Its global mortality has shown an upward trend over the last two decades (2), with a survival rate of less than 5% at 5 years. The poor prognosis is related to late-stage detection since CCA can be asymptomatic in its early stages (3). In Denmark, the estimated cumulative risk of mortality due to CCA was 0.74 for men (ranking 20th in all of Europe) and 0.34 for women (ranking 6th in Europe) (4).

CCA is anatomically classified into three groups: intrahepatic, perihilar, and distal CCA (1,2). Additionally, CCA can be classified as mass-forming, periductal infiltrating, and intraductal based on tumor location, which may be associated with tumor morphology (3). A precise anatomical classification of CCA in each case is essential for accurately assessing potential complications (1).

The diagnosis, staging, and treatment of CCA can be challenging and are typically performed by a multidisciplinary team (MDT) of specialists. MDT meetings are a common practice in cancer care aimed at improving survival. However, it is important to note that there are currently no standardized recommendations for MDT practices in CCA (2). Recently, authors have made efforts to identify areas of improvement and establish standard guidelines for MDT decisions based on the current practices of specialized European teams with expertise in CCA. According to the recommendations of the European Network for the Study of Cholangiocarcinoma, international guidelines should be utilized for MDT decisions. However, preference for national guidelines should be given (2) Nevertheless, at the moment, there are not in Denmark a national guideline to determine the most optimal treatment for CCA patients based on local statistics.

Hence, the objective of this retrospective study was to determine the survival rates of CCA patients based on different therapeutic approaches. Additionally, we aimed to investigate the risk factors associated with poor survival within a cohort of patients treated over a seven-year period across four Danish hospitals. We anticipate that our findings could provide additional evidence for clinical decision-making, improve patient outcomes, and contribute to the knowledge in the field.