Poor Prognosis of Advanced Cholangiocarcinoma: Real-World Data from a Tertiary Referral Center

Abstract

Background: Incidence of cholangiocarcinoma (CCA) in western countries is rising. In the palliative setting, chemotherapy is the only established treatment. The evidence for other treatments including locoregional therapy is low. However, such individual treatments are offered in a realworld setting. The aim of this study is to document the offered treatments and to analyze the survival of patients with unresectable CCA treated at a tertiary referral center. Patients and methods: Data from 220 consecutive patients with CCA treated at a German university cancer center from January 1, 2008, until December 31, 2012. Of those, 105 patients were unresectable. Survival curves were calculated according to the Kaplan-Meier method; log-rank test was applied for survival analysis. Results: Any palliative treatment was beneficial for patients with unresectable CCA when compared to best supportive care (BSC) alone; median OS with BSC was 10 weeks (BSC vs. transarterial chemoembolization [TACE] p = 0.017, HR 0.36; BSC vs. TACE/chemotherapy p < 0.001, HR 0.24; BSC vs. chemotherapy p < 0.001, HR 0.31). Combination of TACE and chemotherapy prolonged overall survival as compared to TACE alone (105 vs. 43 weeks, p = 0.045). Conclusion: Prognosis in advanced stage CCA is still very poor. However, multimodal treatment in palliative patients significantly prolong survival.

Novel Ablation Therapy Using Endoscopic Irreversible Electroporation in the Bile Duct: A Pilot Animal Study

“…However, it is difficult to expect an improvement in the survival rate with this endoscopic treatment. Moreover, this method should only be used as a palliative and supportive treatment [ 2 ]. In addition to various studies using thermal or freezing methods such as radiofrequency ablation or cryotherapy, attempts of selective radioembolization using microspheres containing yttrium-90 have been made.…”

“…Moreover, this method should only be used as a palliative and supportive treatment. 2 In addition to various studies using thermal or freezing methods such as radiofrequency ablation or cryotherapy, attempts of selective radioembolization using microspheres containing yttrium-90 have been made. However, these were only experimental trials owing to concerns about the possible occurrence of complications.…”

“…Cholangiocarcinoma is among the types of cancer with a poor prognosis, and only a few patients with this diagnosis can undergo surgery with complete resection [ 1 ]. Several chemotherapeutic drugs have been introduced; however, the poor prognosis and short survival period limit the treatment of cholangiocarcinoma [ 2 ]. Under these circumstances, several studies evaluating local treatments for cholangiocarcinoma in addition to systemic chemotherapy have been conducted [ 3 ].…”

“…1 Several chemotherapeutic drugs have been introduced; however, the poor prognosis and short survival period limit the treatment of cholangiocarcinoma. 2 Under these circumstances, several studies evaluating local treatments for cholangiocarcinoma in addition to systemic chemotherapy have been conducted. 3 As a prime example of ablation therapy, irreversible electroporation (IRE) can destroy cancer cells in a nonthermal manner.…”

The Emerging Role of Circ-SHPRH in Cancer

“…Although CCA is a relatively rare tumor, its early clinical presentation is atypical, it is highly invasive and it has a poor prognosis. 81 , 82 Intra-and inter-tumor heterogeneity and chemotherapy resistance make it more difficult to treat. 83 Therefore, it is important to elucidate the pathogenesis of this tumor in order to develop more effective treatments.…”