Lee Cheng-Chi, Wu Chun-Ying, Chen Gran-Hum
Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taiwan.
J Gastroenterol Hepatol. 2002 Sep;17(9):1015-20. doi: 10.1046/j.1440-1746.2002.02779.x.
Hepatolithiasis is a well-known etiology of cholangiocarcinoma. However, whether or not hepatolithiasis influences the presentation of cholangiocarcinoma is not very clear. To help clarify this, we conducted the present study to investigate the clinicopathological characteristics of cholangiocarcinoma with hepatolithiasis. As well, we made a comparison between the presence and absence of hepatolithiasis in patients with cholangiocarcinoma to determine the impact of hepatolithiasis.
Among 140 patients with histologically proven cholangiocarcinoma at the Taichung Veteran General Hospital between October 1982 and December 2000, 38 were found to have concomitant hepatolithiasis. Patients were evaluated on the basis of age, gender, presenting symptom, laboratory data, preoperative liver function (indocyanine green test), tumor markers, histological differentiation, lymph node involvement, and organ metastasis. Data were statistically analyzed using the chi-squared test and Student's t-test. Analysis of survival was performed using the Kaplan-Meier method, and univariate analysis and multivariate analyses for survival were performed by Cox proportional hazard model.
The cholangiocarcinoma with hepatolithiasis group (CC + HL) was found to be predominantly female, with more common presentation of fever and less presentation of jaundice (P < 0.05). In addition, patients with cholangiocarcinoma without hepatolithiasis (CC - HL group) had higher serum bilirubin levels and more advanced histological differentiation (P < 0.05). As well, the percentage of resectability of the CC + HL group was higher than that of the CC - HL group, although it was not statistically significant. Univariate and multivariate analyses for overall survival showed that those patients with an age older than 65 years, hypoalbuminemia, poor histological differentiation, and a presence of hepatolithiasis were prone to a graver prognosis, albeit none of them were statistically significant. Resectability was the only independent predictor of a favorable prognosis with significant difference.
The clinicopathological features of cholangiocarcinoma with concomitant hepatolithiasis showed few differences from that without hepatolithiasis. Resectability was the only predictor that favored a good prognosis.
肝内胆管结石是胆管癌的一种已知病因。然而，肝内胆管结石是否会影响胆管癌的表现尚不清楚。为了阐明这一点，我们开展了本研究以调查合并肝内胆管结石的胆管癌的临床病理特征。此外，我们对胆管癌患者有无肝内胆管结石的情况进行了比较，以确定肝内胆管结石的影响。
在1982年10月至2000年12月期间于台中荣民总医院经组织学证实为胆管癌的140例患者中，发现38例合并肝内胆管结石。根据年龄、性别、临床表现、实验室数据、术前肝功能（吲哚菁绿试验）、肿瘤标志物、组织学分化、淋巴结受累及器官转移情况对患者进行评估。数据采用卡方检验和学生t检验进行统计学分析。生存分析采用Kaplan-Meier法，生存的单因素分析和多因素分析采用Cox比例风险模型进行。
发现合并肝内胆管结石的胆管癌组（CC + HL）以女性为主，发热表现更为常见，黄疸表现较少（P < 0.05）。此外，无肝内胆管结石的胆管癌患者（CC - HL组）血清胆红素水平较高，组织学分化程度更高（P < 0.05）。同样，CC + HL组的可切除率高于CC - HL组，尽管差异无统计学意义。总生存的单因素和多因素分析显示，年龄大于65岁、低白蛋白血症、组织学分化差及存在肝内胆管结石的患者预后较差，尽管均无统计学意义。可切除性是唯一具有显著差异的良好预后独立预测因素。
合并肝内胆管结石的胆管癌的临床病理特征与无肝内胆管结石的胆管癌相比差异不大。可切除性是唯一有利于良好预后的预测因素。
