Factors predicting concurrent cholangiocarcinomas associated with hepatolithiasis

Background/Aims: Hepatolithiasis is a risk factor for cholangiocarcinoma. However, it is difficult to detect early cholangiocarcinoma that occurs as a complication of hepatolithiasis. To identify the factors, which can be used for predicting cholangiocarcinomas in patients with hepatolithiasis, we compared the clinical characteristics of patients who had cholangiocarcinoma associated with hepatolithiasis with those of patients with hepatolithiasis only. Methodology: Forty patients with cholangiocarcinoma associated with hepatolithiasis (group HC) and 73 patients with hepatolithiasis only (group H) were randomly selected for this study. Mean tumor size was 6.1+/-2.4 cm in diameter. Results: Patients of group HC were older (56.7 +/- 8.9yr) than those of group H (49.2 +/- 12.9yr) (p<0.001). Weight loss was more frequent in group HC (51.5%) than in group H (5.5%) (p<0.001) and serum alkaline phosphatase levels were higher in group HC (181 184 IU/L) than in group H (426 +/- 385IU/L) (p<0.001). The proportion of the patients who had hepatolithiasis in the right or both lobes of the liver was higher in group HC (72.5%) than in group H (50.6%) (p=0.024). The optimal cutoff value of serum CEA level for cholangiocarcinoma detection was set at 4.2ng/mL using ROC curve to give a sensitivity of 67.6% and a specificity of 90.5%. Group HC differed from group H because of its lower rates of both abdominal pain and cholangitis, longer duration of stone history, and lower serum albumin level. Factors that did not predict cholangiocarcinoma included sex ratio, white blood cell count, serum bilirubin level, and hepatic atrophy. Conclusions: Cholangiocarcinoma should be suspected in patients with hepatolithiasis, especially when, the patient is over 40 years old, has a long history of hepatolithiasis with weight loss, a higher level of serum alkaline phosphatase, a lower level of serum albumin, a serum carcinoembryonic antigen level exceeding 4.2ng/mL, and hepatolithiasis that is located either in the right or both lobes of the liver.