Real-world impact of the management of advanced perihilar and extrahepatic cholangiocarcinoma on prognosis.

BACKGROUND

Cholangiocarcinomas (CCAs), including perihilar CCA (pCCA) and extrahepatic CCA (eCCA), are aggressive cancers with poor prognosis. Most patients are diagnosed at advanced stages. Jaundice and infection, commonly present at diagnosis, can delay treatment initiation. This study aimed to evaluate the impact of these conditions on time to treatment and patient prognosis in a real-world setting.

METHODS

This study included 104 patients with advanced pCCA and eCCA who were evaluated in multidisciplinary team discussions at the University Hospital of Bordeaux between July 2015 and July 2022. We assessed overall survival (OS) and progression-free survival (PFS) in relation to time to treatment initiation, jaundice, biliary drainage, and infection.

RESULTS

Among all patients, 71 patients (68.3%) had metastatic disease and 47 patients (45.2%) had previously received curative intend treatment. Pathological confirmation was obtained in 95 cases (91.3%), with 26 patients requiring multiple biopsy attempts. Biliary drainage was performed in 59 patients (56.7%). The median time from diagnosis to treatment initiation was 6.8 weeks [interquartile range (IQR): 3.5-13.5]. The median OS for the cohort was 67.5 weeks (IQR: 36.6-88.7), and the median PFS was 25.8 weeks (IQR: 14.0-51.6). Analysis revealed no significant differences in OS or PFS related to the time to treatment or the presence of jaundice, biliary drainage, or infection.

CONCLUSIONS

Although jaundice and infection are common at the time of CCA diagnosis and can delay treatment, these factors did not significantly influence prognosis in patients with advanced pCCA and eCCA, whose outcomes remained poor.