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Background/Aims: We aimed to evaluate survival time and prognostic factors in patients with advanced unresectable cholangiocarcinoma who have not re- ceived surgery, chemotherapy, or radiotherapy. Me- thods: A total of 1,377 patients, who were diagnosed with primary cholangiocarcinoma between 1996 and 2002, were reviewed retrospectively according to the following inclusion criteria: histologically proven pri- mary adenocarcinoma arising from the bile-duct epi- thelium, advanced unresectable stages, no severe co- morbidity that can affect survival time, and no history of surgery, chemotherapy, or radiotherapy. Results: Of the 1,377 cases reviewed, 330 patients complied with the inclusion criteria and were thus eligible to participate in this study; 203 had intrahepatic chol- angiocarcinoma and 127 had hilar cholangiocarcinoma. The overall survival time of the entire cohort (n=330) was median 3.9 months (range; 0.2 to 67.1). The sur- vival time was significantly shorter in the intrahepatic cholangiocarcinoma group (3.0±5.3 months) than in the hilar cholangiocarcinoma group (5.9±10.1 months; Kaplan-Meier survival analysis). Multivariate analysis revealed that distant metastasis was a poor prog- nostic factor for intrahepatic cholangiocarcinoma (p 3.0 g/dL was a fa- vorable prognostic factor (p=0.02), and baseline serum carcinoembryonic antigen level >30 ng/mL was a poor prognostic factor for hilar cholangiocarcinoma (p=0.01). Conclusions: The median survival of ad- vanced unresectable cholangiocarcinoma is dismal. (Gut and Liver 2009;3:298-305)