Stefan Buettner1, Georgios A Margonis1, Yuhree Kim1, Faiz Gani1, Cecilia G Ethun2, George Poultsides3, Thuy Tran3, Kamran Idrees4, Chelsea A Isom4, Ryan C Fields5, Bradley Krasnick5, Sharon M Weber6, Ahmed Salem6, Robert C G Martin7, Charles R Scoggins7, Perry Shen8, Harveshp D Mogal8, Carl Schmidt9, Eliza Beal9, Ioannis Hatzaras10, Rivfka Shenoy10, Shishir K Maithel2, Timothy M Pawlik11. 1. Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA. 2. Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA. 3. Department of Surgery, Stanford University Medical Center, Stanford, CA, USA. 4. Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA. 5. Department of Surgery, Washington University School of Medicine, St Louis, MO, USA. 6. Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA. 7. Department of Surgery, University of Louisville, Louisville, KY, USA. 8. Department of Surgery, Wake Forest University, Winston-Salem, NC, USA. 9. Department of Surgery, Ohio State University, Columbus, OH, USA. 10. Department of Surgery, New York University, New York, NY, USA. 11. Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA. Electronic address: tpawlik1@jhmi.edu.
Abstract
BACKGROUND: While traditional survival analyses focus on factors determined at the time of surgery, conditional survival (CS) estimates prognosis relative to time following treatment. We sought to compare actuarial and CS among patients undergoing curative intent surgery for hilar cholangiocarcinoma. METHODS: 242 patients undergoing surgery between 2000 and 2014 were identified using a multi-institutional database. CS was calculated as the probability of surviving an additional 3 years, given that the patient had already survived "x" years from surgery. RESULTS: Median patient age was 67 years (IQR: 57-73) and most patients were male (n = 140, 57.9%). Lymph node metastases were noted in 79 (32.6%) patients while an R0 margin was obtained in 66.1% (n = 160). Median OS was 22.3 months. Actuarial survival decreased over time from 46.3% at 2 years following surgery to 18.2% at 5 years; in contrast, the 3-year CS (CS3) increased with time (CS3 at 2 years was 39.3% versus 54.4% at 5 years). CS3 exceeded actuarial survival for high-risk patients with patients with perineural invasion demonstrating an actuarial survival of 15.4% at 5 years versus CS3 of 37.6% at 2 years following surgery (Δ = 22.2%). CONCLUSIONS: CS provides a more accurate, dynamic estimate for survival, especially among high-risk patients.
BACKGROUND: While traditional survival analyses focus on factors determined at the time of surgery, conditional survival (CS) estimates prognosis relative to time following treatment. We sought to compare actuarial and CS among patients undergoing curative intent surgery for hilar cholangiocarcinoma. METHODS: 242 patients undergoing surgery between 2000 and 2014 were identified using a multi-institutional database. CS was calculated as the probability of surviving an additional 3 years, given that the patient had already survived "x" years from surgery. RESULTS: Median patient age was 67 years (IQR: 57-73) and most patients were male (n = 140, 57.9%). Lymph node metastases were noted in 79 (32.6%) patients while an R0 margin was obtained in 66.1% (n = 160). Median OS was 22.3 months. Actuarial survival decreased over time from 46.3% at 2 years following surgery to 18.2% at 5 years; in contrast, the 3-year CS (CS3) increased with time (CS3 at 2 years was 39.3% versus 54.4% at 5 years). CS3 exceeded actuarial survival for high-risk patients with patients with perineural invasion demonstrating an actuarial survival of 15.4% at 5 years versus CS3 of 37.6% at 2 years following surgery (Δ = 22.2%). CONCLUSIONS:CS provides a more accurate, dynamic estimate for survival, especially among high-risk patients.
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