The DNA index as a prognostic tool in hilar cholangiocarcinoma

J Surg Oncol. 2015 Aug;112(2):214-8. doi: 10.1002/jso.23977. Epub 2015 Jul 29.


Background and objectives: Due to the devastating prognosis of patients suffering from hilar cholangiocarcinoma (HCCA) valid prognostic factors are urgently needed to guide treatment decisions in a personalized concept. The aim of this study was to analyze the predictive value of the DNA index in a large single-center cohort of patients undergoing resection of HCCA.

Methods: A total of 154 patients who underwent resection of HCCA were included in this prospective study. The DNA index was assessed by image cytometry of fresh tumor samples and correlated, as well as standard histopathological parameters, with patient survival.

Results: The median DNA index was 1.61 ± 0.32. Univariate survival analysis identified eight parameters including DNA index, but not DNA ploidy as prognostic markers. In the Cox proportional hazard model DNA index (P = 0.021), tumor size (P = 0.029) and lymph nodes status (P = 0.039) could be shown to be independent predictors of patient survival.

Conclusion: The DNA index represents an independent prognostic marker in HCCA which is superior to most standard histopathological factors. Since the DNA index can be assessed not only post- but also preoperatively, it might be a potential tool in the preoperative decision-making process.

Keywords: DNA ploidy; hilar cholangiocarcinoma; image cytometry; prognosis.

MeSH terms

  • Adult
  • Aged
  • Bile Duct Neoplasms / genetics*
  • Bile Duct Neoplasms / mortality
  • Bile Duct Neoplasms / pathology*
  • Bile Ducts, Intrahepatic / pathology
  • Biomarkers, Tumor / analysis*
  • Cholangiocarcinoma / genetics*
  • Cholangiocarcinoma / mortality
  • Cholangiocarcinoma / pathology*
  • DNA, Neoplasm / analysis*
  • Female
  • Flow Cytometry
  • Hepatectomy* / methods
  • Humans
  • Kaplan-Meier Estimate
  • Lymphatic Metastasis
  • Male
  • Middle Aged
  • Neoplasm Grading
  • Neoplasm Invasiveness
  • Neoplasm Staging
  • Ploidies
  • Predictive Value of Tests
  • Prognosis
  • Prospective Studies


  • Biomarkers, Tumor
  • DNA, Neoplasm