1. Significant Differences in Risk Factors for Perihilar Cholangiocarcinoma (CCA) Compared to Distal CCA: Rationale for Approaching Them as Distinct Entities
Hassan M. Ghoz1, Esha Baichoo1, Benyam Addissie 1, Lewis R. Roberts1, Roongruedee Chaiteerakij2
1Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
 2Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
Background
Baseline Characteristics of Study Cohort
Multivariate Analysis of Potential Risk Factors for pCCA
Summary and Conclusions
Although perihilar (pCCA) and distal (dCCA) share some commonalities and are often grouped as extrahepatic cholangiocarcinoma (ECC), growing evidence suggests that they are separate diseases. Whether the risk factors for pCCA and dCCA are the same is controversial. Gallstones are associated with an increased risk for CCA. It is unclear whether the risk of pCCA and dCCA declines to the baseline population risk level after a cholecystectomy.
1. The risk factors for pCCA and dCCA were different.
2. HCV, cirrhosis, and diabetes were associated with pCCA risk only.
3. Smoking, PSC, IBD, and gallstones were common risk factors for pCCA and dCCA.
4. Cholecystectomy attenuated the risk for pCCA but the risk remained higher than for the general population. This risk reduction was not observed with dCCA.
5. Our results support the proposal that pCCA and dCCA are separate entities.
Variables
pCCA
dCCA
Cases
(n=524)
Controls
(n=1033)
(n=112)
(n=221)
Age, year
62.4 ± 14.0
62.5 ± 14.0
66.3 ± 12.2
66.4 ± 14.0
Male, n (%)
316 (60.3)
620 (60.0)
71 (63.4)
138 (62.4)
White, n (%)
459 (87.6)
925 (89.5)
101 (90.2)
204 (92.3)
Risk factors, n (%)
Smoking
237 (45.2)
413 (40.5)
65 (58.0)
90 (41.3)
Alcohol
283 (54.0)
799 (77.7)
70 (62.5)
169 (76.4)
BMI (>30 kg/m2)
131 (25.0)
254 (26.0)
35 (31.3)
73 (34.1)
PSC*
113 (21.6)
1 (0.01)
9 (8.0)
0 (0)
Diabetes
73 (13.9)
105 (10.4)
24 (21.4)
29 (13.0)
Inflammatory Bowel Disease (Combined)
99 (18.9)
21 (2.0)
12 (10.7)
1 (0.5)
Ulcerative Colitis
78 (14.9)
13 (1.3)
10 (8.9)
Crohn’s Disease
21 (4.0)
8 (0.7)
2 (1.8)
Cirrhosis
28 (5.3)
5 (0.5)
HCV
9 (1.7)
4 (0.4)
2 (0.9)
HBV
5 (1)
Incidental Asymptomatic Gallstones
65 (12.4)
23 (2.2)
14 (12.5)
5 (2.3)
Cholecystectomy for Gallstones
5 (2.26)
Choledochal Cyst
3 (0.6)
1 (0.9)
Variables
AOR(95%CI)
P-value
0.3 ( )
<0.0001
1.5 ( )
0.03
1.6 ( )
<0.0003
1.8 ( )
0.11
3.3 ( )
0.04
4.5 ( )
0.02
8.9 ( )
225 ( x103)
iCCA
pCCA
dCCA
Methods
Adjusted Odds Ratio (AOR)
Multivariate Analysis of Potential Risk Factors for dCCA
References
1. Tyson, G. L. and H. B. El-Serag (2011). "Risk factors for cholangiocarcinoma." Hepatology 54(1):
2. Nordenstedt, H., F. Mattsson, et al. (2012). "Gallstones and cholecystectomy in relation to risk of intra- and extrahepatic cholangiocarcinoma." British journal of cancer 106(5):
Variables
AOR(95%CI)
P-value
1.5 ( )
0.0005
5.7 ( )
0.002
11.3 ( )
0.01
3.9X107
0.0006
Acknowledgments
* PSC: Primary sclerosing cholangitis
Objectives
To compare the risk factors for pCCA and dCCA
To evaluate the decrease in risk of CCA post-cholecystectomy
Adjusted Odds Ratio (AOR)
© 2014 Mayo Foundation for Medical Education and Research