Risk factors for perihilar cholangiocarcinoma: A hospital-based case–control study

Authors

  • Ban Seok Lee,

    1. Department of Medicine, Graduate School, Yonsei University College of Medicine, Seoul, South Korea
    2. Digestive Disease Center and Department of Internal Medicine, Cheju Halla General Hospital, Jeju, South Korea
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  • Byung Hyo Cha,

    1. Digestive Disease Center and Department of Internal Medicine, Cheju Halla General Hospital, Jeju, South Korea
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  • Eun-Cheol Park,

    1. Department of Medicine, Graduate School, Yonsei University College of Medicine, Seoul, South Korea
    2. Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, South Korea
    3. Institute of Health Services Research, Yonsei University College of Medicine, Seoul, South Korea
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  • Jaehoon Roh

    Corresponding author
    1. Department of Medicine, Graduate School, Yonsei University College of Medicine, Seoul, South Korea
    2. Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, South Korea
    • Correspondence

      Dr Jaehoon Roh, MD, PhD

      Department of Preventive Medicine, Yonsei University College of Medicine

      50 Yonsei-ro, Seodaemun-gu, Seoul

      120-752, South Korea

      Tel: +82 2 2228 1867

      Fax: +82 2 392 8133

      e-mail: jhroh@yuhs.ac

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Abstract

Background & Aims

Perihilar cholangiocarcinoma (pCCA) is the most common form of bile duct cancer, arising from cholangiocytes at the confluence of hepatic ducts. Given the diversity of cholangiocarcinoma (CCA) aetiology according to the location, and the scarcity of studies on the aetiology of pCCA, we aimed to identify the risk factors for pCCA.

Methods

A total of 81 patients diagnosed with pCCA between July 2007 and December 2013, and 162 controls matched 2:1 for age, sex and date of diagnosis were included in this hospital-based case–control study. Potential risk factors were retrospectively investigated through clinical records, and the associations with pCCA were studied by calculating the odds ratios (ORs) using conditional logistic regression analysis.

Results

In the univariate model, the prevalence of choledocholithiasis (OR: 14.00, = 0.014), hepatolithiasis (OR: 12.00, = 0.021) and diabetes mellitus (DM) (OR: 2.74, P = 0.005) was higher in pCCA patients than in controls. Heavy smoking and cirrhosis were marginally significant risk factors for pCCA (< 0.1). Multivariate analysis revealed an association between pCCA and hepatolithiasis, choledocholithiasis, DM, and heavy smoking, each, with adjusted ORs of 16.47, 9.39, 3.36 and 2.52 respectively. DM, heavy smoking, hepatolithiasis and choledocholithiasis accounted for about 22.5%, 17.1%, 8.5% and 4.8% of pCCA risk respectively (population attributable risk percentage).

Conclusion

Our data showed that DM, heavy smoking, choledocholithiasis and hepatolithiasis were risk factors for pCCA development, implying that pCCA may share some aetiological factors with intrahepatic CCA although it has been classified as extrahepatic CCA.

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