Cholangiocarcinoma.org Statistics (CONTAINS SURVIVAL STATISTICS)
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This post was first postesd on 6/1/13 and edited on 6/4/13 to correct for the inclusion of Klatskin and other tumor data that was contained in the SEER Bile Duct – Intrahepatic file, but was not intrahepatic cholangiocarcinoma. This data has been eliminated in this revised analysis. Also, some surgery cases where the surgery could not be specifically identified as a resection were included in the previous analysis. These were mostly pre-1998 data where surgical codes were not included in SEER. These were also eliminated in this analysis.
This is my first analysis using SEER (Surveillance Epidemiology and End Results) data. I requested a CDROM when I submitted my application to SEER, but just received a username and password to their online data, so I just used that in this analysis.
SEER has several databases and sites containing cholangiocarcinoma data, some of which is duplication, and some of which is not. I used the database “Incidence – SEER 18 Regs Research Data + Hurricane Katrina Impacted Louisiana Cases, Nov 2012 Sub (1973-2010 varying)” and the Site and Morphology “CS Schema v0204” The SEER 18 database has the latest data which goes through 12/31/2010. I found Intrahepatic CC patients in three ofther Site and Morphology sections, but the CS Schema v0204 had the most, a total of 11,789.
The survival curves below show that a single postive node substantially reduces survival for patients who have resected intrahepatic cholangiocarcinoma.
In the analysis, I eliminated those patients with mutiple cancers, patients who had non-resection surgery, and patients who died from causes other than intrahepatic cc or its complications. A total of 355 patients were used in the analysis. These patients were diagnosed with intrahepatic cc from 1998 – 2010, median 2006. Their ages ranged from 17 – 84, median 59 years.
Median survival is 3.42 years for 0 positive LNs and 1.33 years for 1 positive LN. Statistical parameters for the analysis are Chsq = 33.9, 1 degree of freedom, p = 5.78 e-09. I wanted to do this analyis from the start using the posted Cholangiocarcinoma Foundation data, but never could find sufficient data to get a statistically significant comparison. However, I will add those to the plot in a later post to show comparison between those from the boards and SEER’s.
Bruce Baird
Thanks for that Bruce and I too am looking forward to what you present to us here from the SEER data. Thanks very much.
I just ordered a DVD with the SEER (Surveillance, Epidemiology, and End Results) data for 1973-2010. They didn’t ask for any money, so I guess it’s free. The DVD has the SEER Stat software, SEER binary data for use with the SEER Stat software, and ASCII data which I can use in the R statistical program.
The SEER data contains data for all types of cancer including intrahepatic, perihilar, and extrahepatic cc. The paper by Olivier Farges, et al, which reported research done to develop the AJCC 7th edition TNM staging of patients with resectable intrahepatic cholangiocarcinoma used an earlier version of the SEER data. That version contained data for 598 patients who had undergone cancer-directed surgery for IHCC. Because of the large size of the database, survival statistics developed using this data should be very statistically significant.
Bruce Baird
Bruce…a big thank you is coming your way. Your detailed work is very much appreciated.
How is your wife coming along? We have not received a report on her for quite some time.
Hoping and wishing for the best,
Hugs,
MarionHi, Bruce,
You deserve a big THANKYOU.
In my opinion, 8 of those cases can be completely successful if they were falling into the hands of experienced liver surgeons.
God bless.IHCC – 20%
Perihilar – 16%
ECC – 40%
CC – 24%The ECC may be higher than expected because I collected some data by searching on “Whipple” since I needed more ECC data for one of my planned analyses to compare survival data for all three types.
Many members don’t break their CC down to a lower classification, so I leave that data as just CC.
Most members don’t supply the stage of their cc. For the 25 total cases I only have 5 stages reported, 1 – I or II, 1 – II, and 3 – IV. I suspect the stage IV data reported are restaged data as most surgeons would not resect a stage IV, unless it was stage IVA like my wife.
Below are 19 explanations that I have recorded for the failed surgeries.
1. Failed surgery, cancer had seeded
2. Liver resection failed due to extensive spreading of tumor throughout abdominal cavity
3. Attempted resection on 7/14/08 failed, found spots on liver & 2 small spots on belly wall
4. Attempted resection on 3/25/09 failed, found >10 tumors on LNs near aorta, outside liver
5. Attempted resection in Aug 2005 failed because a few LNs were involved
6. Failed surgery on 11/01/06, blood vessel involvement, GB removed, nicked portal vein.
7. Failed Whipple on 4/28/08 due to finding two spots on liver
8. Failed Whipple on 3/5/07 due to spread to hepatic vein & aorta
9. Failed Whipple found cancer spread to pancreas, liver & other parts
10. Failed 11/15/07 Whipple found cancer spread to GB, liver, duodenum, LNs & around artery
11. Surgery on 12/13/05 failed due to spread to omentum
12. Failed surgery because of mets to main artery found during surgery. GB with mets removed.
13. Failed Whipple found cancer on pancreas & it wasn’t contained
14. Failed Whipple found cancer spread. Later spread to liver, pancreas & some LNs.
15. Surgery failed
16. Surgery failed, found 2 small nodules of cancer in right lobe not detected by CT, removed them.
17. Failed resection on 8/5/11, found unknown small lesions. Ablated all lesions & tumor
18. Attempted resection on 10/30/08 failed, cancer spread
19. Failed surgery on 2/21/07. Tumor tangled around the hepatic vein & arteriesBruce Baird
Hi,Bruce,
Good job and well done.
May I have the % of extra and intrahepatic in your compiled data and the stage of the disease mentioned above.
Thanks.
God bless.A member asked me the following question off-line and my answer may be of interest to other members.
Qustion:
How does it look for someone with CC to be opened up by a surgeon and then be closed because of spread that the scans didn’t pick up?My Answer:
I have compiled data for 557 members so far. Of these 557 members, I have 159 patients who had surgery to perform a resection. Of these 159, a total of 25 (15.7%) of these surgeries failed mostly because the cancer had spread and the spread had not been detected by prior scans and other tests.Bruce Baird
Below is a plot comparing survival statistics for the 12 major US Cancer Centers as a group, other US cancer facilities, and non-US cancer facilities The 12 major US Cancer Centers are those listed in the following link for this organization.
http://www.cholangiocarcinoma.org/majorcancercenters.htm
If a patient was treated at one of these centers or just received a second opinion from one or more of them, that patient was included in this category.
The other US cancer facilities contain all the other cancer facilities in the United States which are not listed as a major cancer center. This list contains a lot of facilities which cc patients have highly recommended and, in some cases, were the only ones that would do certain cc surgeries.
The non-US cancer facilites include all the cancer facilities outside the US.
The statistics on the comparison have a chisq of 10.6, 2 degrees of freedom, p=0.00488.
Median survivals for the three groups are as follows:
Major US Cancer Centers = 2.21 years
Other US Cancer Facilities = 1.90 years
Non-US Cancer Facilities = 1.32 yearsBruce Baird
I asked my surgeon what group has best survivability, he said intrahepatic, in his experience, has the best odds for long term survival, or cure as he called it.The numbers in this group are a little different, at that time he said he had numerous patients survive beyond 5 years when statistics seem to stop.
Hi,
Thanks Bruce,
As far as the p value is so high , the graph is too rough or poor in data to prove one of my thinking that patient over 60 or 65 will do much poor after radioembo than those who are younger in age having chemotherapy either with or without targeted agents.
God bless.The following survival plot compares cc.org patients who have had radioembolization and traditional chemo with patients who have had radioembolization, traditional chemo and targeted agents.
My database only has 11 patients with just chemo and 8 with chemo and targeted agents, so the plots are ragged and definitely not statisticallhy significant, as illustrated by a “p” of 0.916. However, Percy wanted to see this comparison so I am including it in this topic for all to see.
Bruce
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