| Objective To exploit the risk factors of intrahepatic cholangiocarcinoma (ICC) and extrahepatic cholangiocarcinoma (ECC), and clarify the association between Hepatitis B virus (HBV) infection and the clinicopathologic change and prognosis of ICC patients. Furthermore, to identify the prognostic factors of ICC patients and evaluate the tested diagnostic values of tumor makers for distinguishing ICC form hepatocellular carcinoma (HCC).Method Collecting cholangiocarcinoma cases in Peking Union Medical College hospital between 1998 and 2008, and matched them to healthy controls. Information about liver diseases, family history, diabetes, smoking, and drinking were collected on all subjects. Data of part ICC patients were collected and divided into three groups:Group I, HBsAg (hepatitis B virus surface antigen)-positive, anti-HBc (Hepatitis B core antibody)-positive; GroupⅡ, HBsAg-negative, anti-HBc-positive; GroupⅢHBsAg-negative, anti-HBc-negative, whose clinicopathologic features were analyzed and compared. We retrospcctively reviewed and evaluated overall prognosis after resection of part patients, and preoperative serum levels of AFP, CEA, CA19-9, CA242, and CA50 were measured in part ICC and HCC patients.Results The positive rate of HbsAg (＋) and anti-HBc (＋), HbsAg (-) and anti-HBc (＋) and the incidence of choledocholithiasis or hepatolithiasis in ICC patients were 27.9%,50.8% and 14.8%, respectively, while the incidence of diabetes mellitus, cholecyslithiasis, choledocholithiasis or hepatolithiasis and previous cholecystectomy in ECC cases were18.6%,18.3%,22.0% and 13.2%, respectively. All of the higher than those in controls(P<0.05). The prevalence of cirrhosis was higher in patients with ICC than those with ECC P<0.05). The mean age of Group I (P<0.025) and the positive rate of CA19-9 (>25U/ml) (p=0.025) are lower that of than Group III, but the mean PT value (P=0.031), and the frequentation of hepatic cirrhosis (P=0.044) and weight loss (P=0.044) of Group I are higher than those of Group III. In addition, ICC patients in the Group I are more like to get tumor in the right liver, and the patients in the Group III are more like raised tumor in the left liver (P=0.032). Furthermore, patients of Group I have a better outcome compared to those of Group II and Group III (P=0.013). Univariate analysis showed that lyphnode metasis (P=0.019), TNM staging (P=0.010), differentiation grade (P=0.007), serum CA19-9 level (P=0.012) and satellite nodule (P=0.015) were significantly assocated with the prognosis of ICCs, but only satellite nodule and differentiation grade were independent. The serum levels and the positive rate of AFP, CA19-9, and CA242 were significantly different between the ICC patients and HCC patients (P<0.05)Conclusion Choledocholithiasis or hepatolithiasis, liver cirrhosis and chronic HBV infection are possible risk factors for ICC, and choledocholithiasis or hepatolithiasis, diabetes mellitus, cholecyslithiasis, history of cholecystectomy are risk factors for ECC. Choledocholithiasis or hepatolithiasis is risk factor for both ICC and ECC. ICC patients infected by HBV tend to get tumor in a earlier age, and more like to be negative of CA19-9 and get hepatic cirrhosis, and their PT mean value was higher. Moreover, such patients were inclined to get weightless and right liver ICC, but with better outcome. Satellite nodule and differentiation grade were main factors that independently influenced survival of male patients with ICC after resection. The diagnostic value of CA242 (＋), CA19-9 (＋) and AFP (-) can be help in distinguishing ICC from HCC. Combined detection of them can improve the specificity and accuracy of diagnosis of ICC. |
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