Lleo Ana, Colapietro Francesca, Maisonneuve Patrick, Aloise Monia, Craviotto Vincenzo, Ceriani Roberto, Rimassa Lorenza, Badalamenti Salvatore, Donadon Matteo, Pedicini Vittorio, Repici Alessandro, Di Tommaso Luca, Voza Antonio, Torzilli Guido, Aghemo Alessio
Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy.
Internal Medicine Center, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy.
Cancers (Basel). 2021 Apr 25;13(9):2070. doi: 10.3390/cancers13092070.
Cholangiocarcinomas (CCAs) are a heterogeneous group of tumors that arise from the biliary tract. Jaundice is a common clinical presentation; however, the prognostic impact of this symptom is poorly understood, and current management recommendations lack solid evidence. We aim to assess the clinical outcomes and predictive factors of CCA patients presenting with jaundice in the Emergency Room (ER). We retrospectively analyzed all consecutive ER cases presenting with jaundice between January 2010 and December 2017. During the study period, 403,766 patients were admitted to the ER, 1217 (0.3%) presented with jaundice, and in 200 (0.049%), the diagnosis was CCA. CCA cases increased during the study period ( for trend 0.026). Most of them presented with advance disease (stage III 46.5%, stage IV 43.5%) and median survival was 4.5 months (95% CI 3.4-6.0). Factors associated with better survival were age, stage of disease, presence of jaundice at the moment of diagnosis, and lack of concomitant viral hepatitis. A nomogram was constructed that significantly predicts 1-month, 6-month, and 1-year survival after patients' admission. In conclusion, the majority of CCA patients presenting with jaundice to the ER have advanced disease and poor prognosis. Risk stratification of these patients can allow tailored management.
胆管癌（CCAs）是一组起源于胆道的异质性肿瘤。黄疸是常见的临床表现；然而，这种症状对预后的影响尚不清楚，目前的管理建议缺乏确凿证据。我们旨在评估急诊科（ER）中出现黄疸的CCA患者的临床结局和预测因素。我们回顾性分析了2010年1月至2017年12月期间急诊科所有连续出现黄疸的病例。在研究期间，403766名患者入住急诊科，1217例（0.3%）出现黄疸，其中200例（0.049%）诊断为CCA。研究期间CCA病例有所增加（趋势为0.026）。大多数患者表现为晚期疾病（III期46.5%，IV期43.5%），中位生存期为4.5个月（95%CI 3.4-6.0）。与较好生存相关的因素包括年龄、疾病分期、诊断时是否存在黄疸以及是否伴有病毒性肝炎。构建了一个列线图，可显著预测患者入院后1个月、6个月和1年的生存率。总之，大多数因黄疸就诊于急诊科的CCA患者病情已进展且预后较差。对这些患者进行风险分层有助于进行个性化管理。
