Lee Ban Seok, Cha Byung Hyo, Park Eun-Cheol, Roh Jaehoon
Department of Medicine, Graduate School, Yonsei University College of Medicine, Seoul, South Korea; Digestive Disease Center and Department of Internal Medicine, Cheju Halla General Hospital, Jeju, South Korea.
Liver Int. 2015 Mar;35(3):1048-53. doi: 10.1111/liv.12618. Epub 2014 Jul 7.
BACKGROUND & AIMS: Perihilar cholangiocarcinoma (pCCA) is the most common form of bile duct cancer, arising from cholangiocytes at the confluence of hepatic ducts. Given the diversity of cholangiocarcinoma (CCA) aetiology according to the location, and the scarcity of studies on the aetiology of pCCA, we aimed to identify the risk factors for pCCA.
A total of 81 patients diagnosed with pCCA between July 2007 and December 2013, and 162 controls matched 2:1 for age, sex and date of diagnosis were included in this hospital-based case-control study. Potential risk factors were retrospectively investigated through clinical records, and the associations with pCCA were studied by calculating the odds ratios (ORs) using conditional logistic regression analysis.
In the univariate model, the prevalence of choledocholithiasis (OR: 14.00, P = 0.014), hepatolithiasis (OR: 12.00, P = 0.021) and diabetes mellitus (DM) (OR: 2.74, P = 0.005) was higher in pCCA patients than in controls. Heavy smoking and cirrhosis were marginally significant risk factors for pCCA (P < 0.1). Multivariate analysis revealed an association between pCCA and hepatolithiasis, choledocholithiasis, DM, and heavy smoking, each, with adjusted ORs of 16.47, 9.39, 3.36 and 2.52 respectively. DM, heavy smoking, hepatolithiasis and choledocholithiasis accounted for about 22.5%, 17.1%, 8.5% and 4.8% of pCCA risk respectively (population attributable risk percentage).
Our data showed that DM, heavy smoking, choledocholithiasis and hepatolithiasis were risk factors for pCCA development, implying that pCCA may share some aetiological factors with intrahepatic CCA although it has been classified as extrahepatic CCA.
肝门部胆管癌（pCCA）是胆管癌最常见的类型，起源于肝管汇合处的胆管细胞。鉴于胆管癌（CCA）病因因位置而异，且关于pCCA病因的研究较少，我们旨在确定pCCA的危险因素。
本基于医院的病例对照研究纳入了2007年7月至2013年12月期间诊断为pCCA的81例患者，以及按年龄、性别和诊断日期以2:1匹配的162例对照。通过临床记录回顾性调查潜在危险因素，并使用条件逻辑回归分析计算比值比（OR）来研究与pCCA的关联。
在单变量模型中，pCCA患者胆总管结石（OR：14.00，P = 0.014）、肝内胆管结石（OR：12.00，P = 0.021）和糖尿病（DM）（OR：2.74，P = 0.005）的患病率高于对照组。重度吸烟和肝硬化是pCCA的边缘性显著危险因素（P < 0.1）。多变量分析显示pCCA与肝内胆管结石、胆总管结石、DM和重度吸烟之间存在关联，调整后的OR分别为16.47、9.39、3.36和2.52。DM、重度吸烟、肝内胆管结石和胆总管结石分别占pCCA风险的约22.5%、17.1%、8.5%和4.8%（人群归因风险百分比）。
我们的数据表明，DM、重度吸烟、胆总管结石和肝内胆管结石是pCCA发生的危险因素，这意味着pCCA尽管被归类为肝外CCA，但可能与肝内CCA有一些共同的病因因素。
