Survival of patients with HC is relatively poor. Surgery remains the only line of treatment offering the possibility of cure. But most HC patients are at an advanced, unresectable stage when diagnosed. The resectability rate of HC is different from 20to 80% according previous studies.Even in those who can receive radical resection, there is high risk of relapse.The actual 5-year survival after radical resection of HC varieswidely from 14 to 48%[11–17]. We thus performed a single-factor analysis with the subsequent multi-factor analysis to determine the prognostic factors in the surgical resection of HC patients.
As summarized in Table 2, our analysis revealed 7 indexes that could affect prognosis in HC patients. Our study gets the result that height, weight, BMI, ASA grade, serum total bilirubin, ALP, ALT, AST, ALB, operative time, biliary plastic or resect Caudate lobeIt or not are not associated with the prognosis. It also has been previously shown that early stages of TNM staging was a significant good prognosis factor[18] and we get the same result. It is difficult to investigate the true effect of surgical resection and disease prognosis in the clinical because most cases are in advanced stage when diagnosed and do not receive surgical resection.So more people are needed to devote themselves to this field.
CA19-9 has been suggested as a prognostic marker for HC patients undergoing tumor resection[19] in 2014. But Sven H [20] suggested that carcinoembryonic antigen(CEA) but not CA19-9 was an independent prognostic factor in patients undergoing resection of cholangiocarcinoma in 2017. However,we got the conclusion that CA19-9 was an independent prognostic factor of HC patient after surgical in this study.So the prognostic values of CA19-9 in the clinical setting of surgical resection have remained inconclusive. We hold the opinion that serum levels of CA19-9 are also elevated in patients with non-malignant biliary diseases such as primary sclerosing cholangitis or biliary obstruction due to choledocholithiasis[21, 22].Therefore, further related articles are urgently needed.
Many reports indicate that a positive resection margin strongly affects prognosis. Hirano et al. [23] reported that the survival rates among patients with histologically positive margins were significantly inferior to the corresponding rates observed in patients with negative margins. The present study also revealed that proximal margin positivity (hazard ratio [HR], 2.688; p = 0.007) was independent survival prognostic factor[24]. We also got the result that positive margins was an independent prognostic factor. However, several authors have suggested that patients whose positive margins contain carcinoma could survive beyond 5 years. Volkan Öter et.al [25] reported that the survival of patients with tumor positive margins was not found to be worse than those with tumor negative margins. Further large volume prospective studies are required to identify the impact of positive proximal margins on the survival rate.
As we performed single-factor analysis, the statistical tests on imaging staging, lymphatic metastasis, tumor size have statistical -interpretation. But when doing multi-factor analysis, they do not have difference in statistical tests, which indicates they maybe not independent prognostic factors. But Hai-Jie Hu et.al [26] got the conclusion that Bismuth classification type III/IV was independent factors of overall survival in the subgroup of patients who developed early recurrence.Yunfeng Gao[27] reported that Patients with greater numbers of negative lymph nodes had an increased cancer-specifific survival rate compared to patients with fewer negative lymph nodes. In the study of Felice Giuliante[28],the ratio of positive to negative lymph nodes was the only independent prognostic factor for overall survival but was influenced by the total number of retrieved lymph nodes.In this respect, thorough lymph nodes dissection may be important, and should be prospectively evaluated and studied in the future.
The limitations of this study mainly include the following: Only one follow-up was conducted, so it is only suitable for COX analysis, not for survival analysis. It is planned that in the future that further follow-up would be conducted for the survival of such patients until death or loss of follow-up. Some major indicators cannot be studied due to incomplete data, such as CEA, CA125 and postoperative complications.