Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea.
Health Insurance Policy Research Institute, National Health Insurance Service, Wonju, Korea.
Dig Dis Sci. 2018 Dec;63(12):3465-3473. doi: 10.1007/s10620-018-5262-6. Epub 2018 Aug 31.
Cholangiocarcinoma (CCA) often develops after the hepatic resection for hepatolithiasis as well as indwelling it. We studied the incidence and prognosis of subsequent CCA in patients with hepatolithiasis in South Korea.
We identified individuals with diagnosed CCA at the time of or after surgery, during 2002-2016, from the Korean National Health Insurance. The incidences and survival rates of subsequent CCA were analyzed and compared with concomitant CCA. The standardized incidence ratios (SIRs) of CCA in this cohort were evaluated in the standard Korean population. All data were stratified by the presence of intrahepatic or extrahepatic CCA, age and sex.
Of the 7852 patients with hepatectomy for BDS, 433 (5.84%) had concomitant CCA. Over the 12-year follow-up, 107 of 7419 (1.98%) patients were diagnosed with subsequent CCA. Patients with hepatic resection for BDS revealed higher SIRs for subsequent CCA (12.89, 95% CI 10.96-15.15) in cases of both intrahepatic CCA (13.40, 10.55-17.02) and extrahepatic CCA (12.42, 9.98-15.46). The median survival time for subsequent CCA was 0.87 years, while that for concomitant CCA was 2.79 years. Having subsequent CCA (HR 2.71, 95% CI 2.17-3.40) and being male (HR 1.28, 1.05-1.57) were related to a shorter survival time. The CCA site and age at CCA diagnosis were not related to prognoses.
Subsequent CCA developed in 2% of the patients with hepatic resection for benign BDS until 10 years and was associated with poorer prognoses than concomitant CCA. Future studies focused on the long-term surveillance for CCA in such patients are needed.
胆管癌（CCA）常发生于肝内胆管结石行肝切除术后，也可继发于肝内胆管结石。本研究旨在探讨韩国肝内胆管结石患者肝切除术后继发 CCA 的发生率和预后。
我们从韩国国家健康保险系统中确定了 2002 年至 2016 年期间在手术时或手术后诊断为 CCA 的患者。分析并比较了继发 CCA 和同时性 CCA 的发病率和生存率。采用标准化发病比（SIR）评估该队列中 CCA 的发病率，并与标准韩国人群进行比较。所有数据均按肝内或肝外 CCA、年龄和性别进行分层。
在 7852 例行肝切除术治疗 BDS 的患者中，有 433 例（5.84%）合并 CCA。在 12 年的随访中，7419 例患者中有 107 例（1.98%）被诊断为继发 CCA。肝内胆管结石患者行肝切除术治疗 BDS 时，其继发 CCA 的 SIR 更高（12.89，95%CI 10.96-15.15），肝内 CCA 为 13.40（10.55-17.02），肝外 CCA 为 12.42（9.98-15.46）。继发 CCA 的中位生存时间为 0.87 年，同时性 CCA 为 2.79 年。继发 CCA（HR 2.71，95%CI 2.17-3.40）和男性（HR 1.28，1.05-1.57）与较短的生存时间相关。CCA 部位和 CCA 诊断时的年龄与预后无关。
肝内胆管结石行肝切除术治疗良性 BDS 的患者在 10 年内有 2%发展为继发 CCA，其预后较同时性 CCA 差。需要进一步研究此类患者 CCA 的长期监测。
