Carcinoma of the extrahepatic biliary system:: Correlation of clinical, pathological, histological and DNA-cytometric parameters with prognosis

Background: Studies concerning the prognosis of all carcinomas of the extrahepatic biliary system together (EBC) do not exist, so far. A detailed and valid histopathological grading-system is lacking and the prognostic relevance of DNA-cytometric parameters is not clear. Methods: 81 patients with EBC underwent surgical treatment. Clinical, pathological, histomorphological and DNA-cytometric parameters were evaluated. The influence on prognosis was tested in univariate and multivariate analysis. Results: Apart from significant perioperative mortality (17%) survival was markedly dependent on the presence of tumor remnants in resection margins. After incomplete and complete resection, the median survival was 5 and 19 months, respectively (p < 0.0001). Further parameters with significant prognostic relevance were tumor localization pTNM-stage, period of complaints, presence of gallstones, histological type and DNA-index. Multivariate analysis however demonstrated only two independent prognostic factors: status of resection margins and tumor localization. Conclusions: Histomorphological- and DNA-cytometric parameters failed to demonstrate an additional significant influence on the prognosis in EBCs. Apart from perioperative mortality the survival of patients with EBC predominantly depends on tumor localization and the status of resection margins.