Abdul Waheed, MD, Jill S Motl, MD, Justin Kelly, MD, FRCS, Rebecca Rowen, MD, John R Monson, MD, FACS, FRCS, FASCRS. Surgical Health Outcomes Consortium, Florida Hospital Medical Center, Orlando, FL, USA
Introduction: Klatskin tumors (KT) occur at the confluence of right and left extrahepatic ducts and classified based on their anatomical and histological code in the International Classification of Diseases for Oncology (ICD-O). The second edition of ICD-O (ICD-O-2) allocated a distinctive histological code to KT, which was cross-referenced to the intrahepatic cholangiocarcinomas. This unclear coding may result in ambiguous reporting of the demographical and clinical features of KT. The current study aims to investigate the demographic, clinical and pathological factors impacting prognosis and survival of KT in the light of updated third edition of ICD-O (ICD-O-3).
Methods: Data on 1,144 KT patients from the Surveillance Epidemiology and End Result (SEER) database (2001-2012) was abstracted. KT patients were analyzed for age, gender, race, stage, treatment, and long-term survival. The data was analyzed using Chi-square tests, T-tests, univariate and multivariate analysis. Kaplan- Meier analysis was used to compare long-term survival between KT and sub-groups of all biliary cholangiocarcinomas (CC).
Results: Of all biliary CC, KT comprised of 9.35 % with the mean age of diagnosis 73±13 years, was more common in males (54.8%) and Caucasians patients (69.5%). Histologically, moderately differentiated tumors were commonest (38.9%), followed by poorly differentiated (35.7%), well differentiated (23.3%) and undifferentiated tumors (2.2%), p=<0.001. Most tumors in KT group were 2-4 cm (41.5%), while fewer were >4cm (29.7%), and <2cm (28.8%), p=<0.001. ICD-O-3 defined most KT tumors in extrahepatic location (53.5%), while the remainder were in other biliary locations (46.5%), p=<0.001. Most KT patients received no treatment (73%), and those who were treated, the most frequent modality was radiation (52.7%), followed by surgery (28.1%), and both surgery and radiation (19.2%), p=<0.001. Mean survival time for KT patients treated with surgery was inferior to all CC of the biliary tree (1.72 ±2.61 vs. 1.87 ±2.18 years). P=0.047. Multivariate analysis identified regional metastasis (OR=2.8, CI=2.6-3.0), distant metastasis (OR=2.1, CI=1.9-2.4), lymph node positivity (OR=1.6, CI=1.4-1.8), Caucasian race (OR=2.0, CI=1.8-2.2), and male gender (OR=1.2, CI=1.1-1.3) to be independently associated with increased mortality for KT, p<0.001.
Conclusion: ICD-O-3 has permitted greater understanding of Klatskin tumors. This is a rare and lethal biliary malignancy that presents most often in Caucasian males in their seventh decade of life with moderately differentiated histology. Surgical resection does not provide any survival advantage compared to similarly treated biliary CC. Also, the combination of surgery and radiation appeared to provide no added survival benefits compared to other treatment modalities for KT.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87940
Program Number: P119
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster