A proposed severity classification system for hepatolithiasis based on an analysis of prognostic factors in a Japanese patient cohort

Background Hepatolithiasis frequently results in severe complications. We conducted a cohort study to identify prognostic factors and to establish a hepatolithiasis severity classification system. Methods The study cohort comprised 396 patients who were identified through a 1998 nationwide survey an...

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Published in:Journal of gastroenterology 2018-07, Vol.53 (7), p.854-860
Main Authors: Suzuki, Yutaka, Mori, Toshiyuki, Yokoyama, Masaaki, Kim, Sangchul, Momose, Hirokazu, Matsuki, Ryota, Kogure, Masaharu, Abe, Nobutsugu, Isayama, Hiroyuki, Nakazawa, Takahiro, Notohara, Kenji, Tanaka, Atsushi, Tsuyuguchi, Toshio, Tazuma, Susumu, Takikawa, Hajime, Sugiyama, Masanori
Format: Article
Language:English
Subjects:
Abdominal Surgery
Analysis
Biliary Tract
Cholangiocarcinoma
Cirrhosis
Classification
Cohort analysis
Colorectal Surgery
Diagnosis
Gastroenterology
Health aspects
Hepatology
Jaundice
Liver
Liver cirrhosis
Medical prognosis
Medical research
Medicine
Medicine & Public Health
Medicine, Experimental
Original Article—Liver
Pancreas
Patients
Risk factors
Surgical Oncology
Surveys
Survival
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Summary:Background Hepatolithiasis frequently results in severe complications. We conducted a cohort study to identify prognostic factors and to establish a hepatolithiasis severity classification system. Methods The study cohort comprised 396 patients who were identified through a 1998 nationwide survey and followed up for 18 years or until death. Cox regression analysis was used to identify prognostic factors. Results Median survival time of the patients was 308 (range 0–462) months. Of the 396 patients enrolled in the study, 118 (29.8%) died, most frequently from intrahepatic cholangiocarcinoma (25 patients, 21.2%). Age of ≥ 65 years at the time of initial diagnosis [hazard ratio (HR) 3.410], jaundice for ≥ 1 week during follow-up (HR 2.442), intrahepatic cholangiocarcinoma (HR 3.674), and liver cirrhosis (HR 5.061) were shown to be significant risk factors for death from any therapeutic course. The data led to a 3-grade disease severity classification system that incorporates intrahepatic cholangiocarcinoma and liver cirrhosis as major factors and age of ≥ 65 years and jaundice for ≥ 1 week during follow-up as minor factors. Survival rates differed significantly between grades. Conclusions The proposed hepatolithiasis severity classification system can be used to assess prognosis and thereby improve patient outcomes.
ISSN:0944-1174
1435-5922
DOI:10.1007/s00535-017-1410-6