Asian Pacific Journal of Cancer Prevention, Vol 14, 2013 1623 DOI:http://dx.doi.org/10.7314/APJCP.2013.14.3.1623 Factors Affecting Survival Time of Thai Cholangiocarcinoma Patients Asian Pacific J Cancer Prev, 14 (3), 1623-1627 Introduction Liver cancer was the fifth most common cancer in men, the seventh in women and the third most common cause of death in both sexes from cancer worldwide in 2008, and almost 85% of the cases occur in developing countries (Ferlay et al., 2010). Cholangiocarcinoma (CCA) is the second most common type of liver cancer and accounted for an estimated 15% of primary liver cancer worldwide (Parkin et al., 1993). However, CCA is very common in north-east Thailand, where it accounts for between 58% and 89% of primary liver cancers of men (Parkin et al., 1993; Vatanasapt et al., 1995; Sriplung et al., 2005; Kamsa-ard et al., 2011), and is the most common cause of death from cancer (Vatanasapt et al., 1990). Most cases are clinically silent in the early stages of disease, and are detected at an advanced stage (Blechacz et al., 2008; Mihalache et al., 2010), with a correspondingly poor prognosis. The median survival is about 4-5 months (Mihalache et al., 2010; Yusoff et al., 2012) and one-year survival between 22% and 28% (Sriamporn et al., 1995; Mihalache et al., 2010). Survival time of patients with CCA can be improved by early detection followed by curative resection (Blechacz et al., 2008; Mihalache et al., 2010; Li et al., 2011). Unfortunately, only few CCA 1 Department of Epidemiology, Faculty of Public Health, Khon Kaen University, 2 Department of Community Health, Faculty of Public Health, Ubon Ratchathani Rajabhat University, Thailand, 3 Clinical Trial Service Unit & Epidemiological Studies Unit, University of Oxford, United Kingdom *For correspondence: supannee@kku.ac.th Abstract Cholangiocarcinoma (CCA) is a major health problem and cause of death among people in Northeastern Thailand. In this prospective study 171 patients newly diagnosed with CCA by physicians in 5 tertiary hospitals in four provinces of northeastern of Thailand between February and July 2011 were followed up to January 2012. The outcome was survival time from diagnosis to death. A total of 758.4 person-months of follow-up were available. The mortality rate was 16.9 per 100 person-months (95%CI: 14.1-20.1). The median survival time among CCA patients was 4.3 months (95%CI: 3.3-5.1). Cox’s proportional hazard model was used to study the independent effects of factors affecting survival time among patients. Statistically significant factors included advanced stage at diagnosis (HR: 2.5, 95%CI: 1.7-3.8), presentation with jaundice (HR: 1.7, 95%CI: 1.1-2.4) or ascites (HR: 2.8, 95%CI: 1.8-4.4), and positive serum carcinoembryonic antigen (HR: 2.3, 95%CI: 1.2-4.3). Patients who had received standard treatment had a better prognosis that those who did not (HR: 0.5, 95%CI: 0.3-0.7). Keywords: Cholangiocarcinoma - survival - clinical factor - conventional treatment - alternative medicine RESEARCH ARTICLE Factors Affecting Survival Time of Cholangiocarcinoma Patients: A Prospective Study in Northeast Thailand Somkiattiyos Woradet 1 , Supannee Promthet 1 *, Nopparat Songserm 2 , Donald Maxwell Parkin 3 patients are eligible for curative surgery (Mihalache et al., 2010; Yusoff et al., 2012). Previous studies of survival in CCA patients have focused on specific subgroups- such as those at advanced stage (Park et al., 2009), receiving surgical resection (Murakami et al., 2011; Pattanathien et al., 2013; Sriputtha et al., 2013) or adjuvant therapy (Knüppel et al., 2012), or specific tumour locations (Cheng et al., 2007; Hasegawa et al., 2007; Nakagohri et al., 2008; Guglielmi et al., 2009; Bunsiripaiboon et al., 2010; Cho et al., 2010; Nuzzo et al., 2010; Li et al., 2011). In addition, most studies were retrospective, only one prospective study (Mihalache et al., 2010) has been reported, and there are none from Asian countries. To our knowledge, there has been no previous prospective study among unselected patients of the factors affecting survival of CCA patients in Thailand. Materials and Methods Study design The subjects enrolled into the study were newly diagnosed as CCA by at least one of the following six diagnostic procedures: ultrasonography (U/S), computed tomography (CT), magnetic resonance imaging (MRI), magnetic resonance cholangiopancreatography (MRCP),