Serum albumin predicts survival in patients with hilar cholangiocarcinoma

Background and aims:Hilar cholangiocarcinoma is a devastating malignancy with incidence varying by geography and other risk factors.Rapid progression of disease and delays in diagnosis restrict the number of patients eligible for curative therapy.The objective of this study was to determine prognostic factors of overall survival in all patients presenting with hilar cholangiocarcinoma.Methods:All adult patients with histologically confirmed hilar cholangiocarcinoma from 2003 to 2013 were evaluated for predictors of survival using demographic factors,laboratory data,symptoms and radiological characteristics at presentation.Results:A total of 116 patients were identified to have pathological diagnosis of hilar cholangiocarcinoma and were included in the analysis.Patients with a serum albumin level>3.0 g/dL(P<0.01),cancer antigen 19-9≤200U/mL(P=0.03),carcinoembryonic antigen≤10g/L(P<0.01)or patients without a history of cirrhosis(P<0.01)or diabetes(P=0.02)were associated with a greater length of overall survival.A serum albumin level>3.0 g/dL was identified as an independent predictor of overall survival(hazard ratio 0.31;95%confidence interval 0.14–0.70)with a survival benefit of 44 weeks.Conclusion:This study was the largest analysis to date of prognostic factors in patients with hilar cholangiocarcinoma.A serum albumin level>3.0 g/dL conferred an independent survival advantage with a significantly greater length of survival.

Recurrence and survival rates of inflammatory bowel disease-associated colorectal cancer following postoperative chemotherapy:a comparative study

Background and Aim:Inflammatory bowel disease(IBD)is associated with an increased risk of colorectal cancer(CRC).Studies have shown tumorigenetic and histomorphological differences between IBD-associated CRC and non-IBD CRC,suggesting differences in tumor behavior and response to treatment.We aimed to compare tumor recurrence and survival rates following postoperative chemotherapy in CRC patients with and without IBD.Methods:Search of the Cleveland Clinic’s CRC database revealed 65 patients who had IBD-associated CRC and received postoperative adjuvant chemotherapy between 1994 and 2010.Twenty-one patients were excluded due to incomplete clinical data.Propensity score-matching based on age,surgery intent,CRC site,tumor grade,American Joint Committee on Cancer(AJCC)stage and T stage was used to match IBD and non-IBD patients(1:4).Competing risk and Cox regression models were used to analyze differences in disease-free survival and overall survival,respectively.Results:Forty-four patients with IBD-associated CRC were matched to 176 patients with non-IBD CRC.Among IBD patients,29(66%)had ulcerative colitis,14(32%)had Crohn’s disease,and one(2%)had indeterminate colitis.Mean IBD diagnosis age was 28.1±14.5 years,and mean IBD duration at time of CRC treatment was 21.5±12.6 years.Ten(23%)IBD patients had tumor recurrence compared with 34(19%)non-IBD patients(P=.074).There was no significant difference in disease-free survival(hazard ratio[HR]=0.60;95%CI:0.35–1.05;P=0.074)or overall survival(HR=0.87;95%CI:0.54–1.4;P=0.58)between IBD and non-IBD patients.Conclusion:Patients with IBD-associated CRC have comparable rates of tumor recurrence and survival following postoperative chemotherapy as CRC patients without IBD.Prospective studies are needed to confirm these findings and guide therapeutic decisions.