Clinical presentation, diagnosis, and survival in cholangiocarcinoma: A prospective study

Background and study aims: The diagnosis of cholangiocarcinoma (CCA) is difficult. The present study aimed to assess the clinical features, diagnosis, and survival in CCA. Patients and methods: This is a prospective study on 46 patients with CCA who underwent endoscopic retrograde cholangiopancreatography (ERCP) or surgical resection and 20 controls with a clinical and ERCP suspicion for CCA in whom surgical biopsy and/or 4-year follow-up showed a benign biliary stricture. Results: The median age at presentation was 71 years (range 44-88). Thirty-four patients (73.9%) presented with painless jaundice. Median CA 19-9 value was 188IU/L (range 1-49,138), with a level of <100 ILK in 13 patients (28%). Total bilirubin was 11.9 (0.6-36.3) mg/dL. The tumour was intrahepatic in 3 (6.5%), hilar (Klatskin) in 25 (54.3%), and located in the lower third of the bile duct in 18 (39.1%) patients. The diagnosis was confirmed by positive cytology in 10 (21.7%), biopsy in 20 (43.5%), cholangioscopy in five (10.9%), and imaging and clinical grounds in 11 (23.9%) patients. Cytology was feasible in 36 patients; it was positive in 10 and "highly indicative" in two patients (33.3% sensitivity). Twenty-two patients (47.8%) were treated by surgical resection, and the rest were offered palliative biliary drainage. Mean estimated survival for the entire group of CCA patients was 21.5 +/- 3.3 months. Survival was slightly longer in patients who underwent surgical resection than those who had palliative treatment; the estimated mean survival rates were 26.2 +/- 4.2 vs. 17.1 +/- 3.3 months, respectively, but the difference was not statistically significant (p = 0.115). Conclusion: The diagnosis of CCA is difficult and often delayed. The outcome is generally poor. (C) 2016 Pan-Arab Association of Gastroenterology. Published by Elsevier B.V. All rights reserved.