Predictive factors for subsequent intrahepatic cholangiocarcinoma associated with hepatolithiasis: Japanese National Cohort Study for 18 years

Background 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. Methods This cohort is comprised of 401 p...

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Published in:Journal of gastroenterology 2022-05, Vol.57 (5), p.387-395
Main Authors: Suzuki, Yutaka, Mori, Toshiyuki, Momose, Hirokazu, Matsuki, Ryota, Kogure, Masaharu, Abe, Nobutsugu, Isayama, Hiroyuki, Tazuma, Susumu, Tanaka, Atsushi, Takikawa, Hajime, Sakamoto, Yoshihiro
Format: Article
Language:English
Subjects:
Abdominal Surgery
Bile Duct Neoplasms - diagnosis
Bile Ducts, Intrahepatic
Biliary Tract
Calculi
Carcinogenesis
Cholangiocarcinoma
Cholangiocarcinoma - diagnosis
Cohort analysis
Cohort Studies
Colorectal Surgery
Constriction, Pathologic
Gastroenterology
Hepatology
Humans
Japan - epidemiology
Lithiasis - complications
Lithiasis - diagnosis
Lithiasis - epidemiology
Liver Diseases - complications
Malignancy
Medicine
Medicine & Public Health
Middle Aged
Neoplasm Recurrence, Local
Original Article—Liver
Pancreas
Patients
Stricture
Surgical Oncology
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Summary:Background 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. Methods 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. Results 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. Conclusions Regarding carcinogenesis, complete stone clearance and releasing biliary stricture can prevent the development of intrahepatic cholangiocarcinoma and improve the prognosis of hepatolithiasis.
ISSN:0944-1174
1435-5922
DOI:10.1007/s00535-022-01868-6