Clinical commentaryCholangiocarcinoma with spinal metastasis: Single center survival analysis

- Cholangiocarcinoma (CCA) is an epithelial cell malignancy arising from various locations within the biliary tree.
- CCA with spinal metastases had a poor median survival.
- A single level of affected spine and a Frankel scale of C or better demonstrated significantly longer median survival.
- A moderate to high Kanofsky score, and radiation therapy showed significant longer median survival.
- CCA resection and spinal surgery, combine with adjuvant treatments, may play an important role in prolonging survival.

The aim of this study was to perform a survival analysis of Cholangiocarcinoma (CCA) with spinal metastases. 55 cases of CCA with spinal metastases were retrospectively reviewed. We recorded age, sex, Kanofsky performance score, Frankel scale, number and region of affected vertebrae, presence of appendicular bone metastases, treatment received, and survival time; then performed a survival analysis. Overall median survival was 4 months (95%CI, 2.89-5.11). Frankel A had the poorest survival (2 months-95%CI, 1.15-2.85) compared to Frankel C and D (P = 0.004 and <0.001, respectively). One-level spinal metastasis had the longest survival (8 months-95%CI, 5.98-10.02) compared to two-level and more than two-level involvement (P = 0.036 and 0.001, respectively). The higher Kanofsky score had the longer survival (11 months-95%CI, 9.61-12.39) compared with the low and moderate score groups (P < 0.001 and 0.012, respectively). Radiation therapy had a survival of 6 months (95%CI, 3.41-8.59), significantly longer than the 3 months for palliative spine surgery and 2 months for palliative treatment alone. CCA resection and palliative spine surgery-when performed together and/or combined with other adjuvant treatment(s)-had a survival time of longer than 9 months. In conclusion, CCA with spinal metastases had a poor median survival. A single level of affected spine, a Frankel scale of C or better, a moderate to high Kanofsky score, and radiation therapy were associated with significantly longer median survival. CCA resection and spinal surgery may play an important role in prolonging survival when used in conjunction with other adjuvant treatment modalities.