Baton et al identified prognostic factors for advanced Klatskin tumors with extension into the common bile duct (Bismuth Types 3 and 4 hilar cholangiocarcinomas). This can help identify patients who may have a reasonable prognosis. The authors are from Hopital Paul Brousse in Villejuif, France.
Patient selection: hepatectomy for hilar cholangiocarcinoma, Bismuth Type 3 or 4
Prognostic factors:
(1) days for the serum total bilirubin to return to normal
(2) parenchymal margin status
(3) preoperative chemotherapy
(4) gender of the patient
(5) celiac lymph node status
|
Parameter |
Finding |
Points |
|
days for serum bilirubin to return to normal |
<= 30 days |
0 |
|
|
> 30 days |
1 |
|
parenchymal margin |
negative for tumor |
0 |
|
|
positive for tumor (R1) |
1 |
|
preoperative chemotherapy |
given |
0 |
|
|
not given |
1 |
|
gender of patient |
female |
0 |
|
|
male |
1 |
|
celiac lymph nodes |
negative for tumor |
0 |
|
|
positive for tumor |
1 |
number of poor prognostic factors present =
= SUM(points for all 5 parameters)
Interpretation:
• minimum number of poor prognostic factors: 0
• maximum number of poor prognostic factors: 5
• The prognosis is poor when multiple poor prognostic factors are present.
|
Pattern of Prognostic Factors |
5 Year Survival |
|
0 poor prognostic factors |
75% |
|
3 to 5 poor prognostic factors |
0% |
|
positive celiac lymph node(s) |
0% (3% if only finding) |
|
2 poor prognostic factors (except celiac lymph node) |
3 - 9% |
|
1 poor prognostic factor with male gender |
32% |
|
1 poor prognostic factor in female with negative celiac lymph nodes |
41 - 43% |
based on Table 6, page 257
Specialty: Hematology Oncology, Surgery, general, Gastroenterology
ICD-10: ,
