Meta Analysis Of Risk Factors For Intrahepatic Bile Duct Stones Progresses To Intrahepatic Cholangiocarcinoma

Objective:In this paper,Meta analysis was used to explore the progress of intrahepatic bile duct stones as a reliable risk factor for intrahepatic bile duct carcinoma,and to provide basis for early diagnosis and early treatment of high-risk population with intrahepatic bile duct stones progresses to intrahepatic cholangiocarcinoma.Methods:The articles about risk factors for intrahepatic bile duct stones progresses to intrahepatic cholangiocarcinoma that had been published in PubMed,Embase,The Cochrane Library,Embase,China Biomedical Database(CBM),CNKI and VIP by December 2020 were searched.Endnote-X9 was used for literature management,and STATAMP 14 software was used for Meta-analysis.Newcastle-Ottawa Scale(NOS)was used to evaluate the quality of the included articles.Results:Ten articles were included,all of which were case-control studies.2350 patients were enrolled toally,including 469 patients in the case group(intrahepatic bile duct stones with intrahepatic cholangiocarcinoma group)and 1882 patients in the control group(including 1784 patients with simple intrahepatic bile duct stones and 98 patients with inflammatory mass).In this Meta analysis,the risk factors such as choledochojejunostomy,diabetes,early lithotomy history,family history of cancer,hepatitis B and the course intrahepatic bile duct stones>10 years,intrahepatic bile duct cyst,liver parasite,hyperlipidemia,thoroughly remove,liver cirrhosis,history of gastric resection,liver atrophy,bile duct stricture correction,smoking,and tumor markers(CA199,CA125,CEA)increases were included.All risk factors included in the Meta analysis were independent risk factors in the original study.Results of Meta analysis were as follows:choledochojejunostomy(OR=4.71,95%CI=3.06-7.02,P<0.00001),diabetes(OR=4.37,95%CI=2.3-8.32,P<0.00001),family history of tumor(OR=9.04,95%CI=3.16-25.87,P<0.0001),elevated CA199(OR=5.03,95%CI=2.65-9.57,P<0.00001),liver cirrhosis(OR=4.14,95%CI=2.24-7.63,P<0.00001),the course intrahepatic bile duct stones>10 years(OR=2.71,95%CI=1.73-4.24,P<0.0001)were risk factors for intrahepatic bile duct stones progresses to intrahepatic cholangiocarcinoma.Early lithotomy history(OR=0.32,95%CI=0.17-0.6,P=0.0004)was the protective factor.Risk factors such as complete removal of stones,elevated CA125,elevated CEA,history of hepatitis B,intrahepatic bile duct cyst,history of hepatic parasites,hyperlipidemia,history of gastrectomy,liver atrophy,smoking,correction of bile duct stricture,etc.,were not able to conduct this study due to insufficient original data or too much heterogeneity in the Meta analysis.Conclusions:1.Choledochojejunostomy,diabetes,family history of tumor,elevated CA199,liver cirrhosis,and the course intrahepatic bile duct stones>10 years are independent risk factors for intrahepatic cholangiocarcinoma in the progression of intrahepatic cholangiolithiasis;2.Early lithotomy history can prevent the progression of intrahepatic bile duct stones to intrahepatic cholangiocarcinoma.