Department of Gastrointestinal and General Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan.
Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo, Japan.
J Gastroenterol. 2022 May;57(5):387-395. doi: 10.1007/s00535-022-01868-6. Epub 2022 Mar 31.
Predictive factors for intrahepatic cholangiocarcinoma in long-term follow-up of hepatolithiasis are unknown. We thus conducted a cohort study to investigate the predictive factors for developing intrahepatic cholangiocarcinoma in hepatolithiasis.
This cohort is comprised of 401 patients registered in a nationwide survey of hepatolithiasis for 18 years of follow-up. Cox regression analysis was used to elucidate predictive factors for developing intrahepatic cholangiocarcinoma.
The median follow-up period of patients was 134 months. Twenty-two patients developed intrahepatic cholangiocarcinoma and all died. Identified independent significant factors were as follows: age 63 years or older (hazard ratio [HR] 3.344), residual stones at the end of treatment (HR 2.445), and biliary stricture during follow-up (HR 4.350). The incidence of intrahepatic cholangiocarcinoma in patients with three factors was significantly higher than that in patients with one or two factors. The incidence in the groups with one or two predictive factors was not different. In 88.9% of patients with both biliary stricture and intrahepatic cholangiocarcinoma, the duration between the diagnoses of biliary stricture and intrahepatic cholangiocarcinoma was ≥ 5 years. However, once intrahepatic cholangiocarcinoma developed, 77.8% of patients died within 1 year. Of 24 patients with no symptoms, no previous choledocoenterostomy, no signs of malignancy, no biliary stricture, and no treatment for hepatolithiasis during follow-up, only one developed intrahepatic cholangiocarcinoma.
Regarding carcinogenesis, complete stone clearance and releasing biliary stricture can prevent the development of intrahepatic cholangiocarcinoma and improve the prognosis of hepatolithiasis.
在长期随访的肝胆管结石病中，肝内胆管癌的预测因素尚不清楚。因此，我们进行了一项队列研究，以调查肝胆管结石病患者发生肝内胆管癌的预测因素。
该队列包括在全国范围内进行的肝胆管结石病调查中登记的 401 例患者，随访时间为 18 年。采用 Cox 回归分析阐明发生肝内胆管癌的预测因素。
患者的中位随访时间为 134 个月。22 例患者发生肝内胆管癌，均死亡。确定的独立显著因素如下：年龄 63 岁或以上（风险比 [HR] 3.344）、治疗结束时残留结石（HR 2.445）和随访期间胆管狭窄（HR 4.350）。有三个因素的患者的肝内胆管癌发生率明显高于有一个或两个因素的患者。有一个或两个预测因素的组的发生率没有差异。在有胆管狭窄和肝内胆管癌的 88.9%的患者中，胆管狭窄和肝内胆管癌的诊断间隔时间≥5 年。然而，一旦发生肝内胆管癌，77.8%的患者在 1 年内死亡。在 24 例无症状、无先前胆肠吻合术、无恶性征象、无胆管狭窄且在随访期间未接受肝胆管结石病治疗的患者中，仅 1 例发生肝内胆管癌。
就癌变而言，完全清除结石和解除胆管狭窄可以预防肝内胆管癌的发生，并改善肝胆管结石病的预后。
