Gut and Liver Natural Course and Risk of Cholangiocarcinoma in Patients with Recurrent Pyogenic Cholangitis: A Retrospective Cohort Study
Author Information
Min su You1, Sang Hyub Lee1, Jinwoo Kang1, Young Hoon Choi1, Jin Ho Choi1, Bang-sup Shin1, Gunn Huh1, Woo Hyun Paik1, Ji Kon Ryu1, Yong-Tae Kim1, Dong Kee Jang2, and Jun Kyu Lee2
1Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, and 2Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea

Sang Hyub Lee
Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea
Tel: +82-2-2072-2228, Fax: +82-2-762-9662, E-mail: gidoctor@snuh.org
© The Korean Society of Gastroenterology, the Korean Society of Gastrointestinal Endoscopy, the Korean Society of Neurogastroenterology and Motility, Korean College of Helicobacter and Upper Gastrointestinal Research, Korean Association the Study of Intestinal Diseases, the Korean Association for the Study of the Liver, Korean Pancreatobiliary Association, and Korean Society of Gastrointestinal Cancer. All rights reserved.

Abstract
Background/Aims: Recurrent pyogenic cholangitis (RPC) is a chronic, progressive disease frequently accompanied by cholangiocarcinoma (CCA). This study aimed to investigate the natural course of RPC and identify factors associated with CCA. Methods: From January 2005 to December 2016, 310 patients with RPC at Seoul National University Hospital were included. Complications and management during follow-up were recorded. CCA-free probability was estimated by the Kaplan-Meier method, and risk factors associated with CCA were analyzed using the log-rank test and Cox proportional hazards regression model. Results: The mean age at diagnosis was 59.1±10.9 years, and the mean follow-up duration was 84.0±64.1 months. An intrahepatic duct stone was found in 253 patients (81.6%). Liver atrophy was identified in 185 patients (59.7%) and was most commonly located at the left lobe (65.4%). Acute cholangitis, liver abscesses, cirrhotic complications, and CCA developed in 41.3%, 19.4%, 9.7%, and 7.4% of patients, respectively. During follow-up, the complete resolution rate after hepatectomy, biliary bypass surgery, and choledocholithotomy with T-tube insertion reached 82.3%, 55.2%, and 42.1%, respectively. None of the patients who maintained complete resolution by the last follow-up day developed CCA. In a univariable analysis, female, both-sided intrahepatic duct stones, and liver atrophy at any location were associated with increased risk of CCA. Multivariable analysis revealed that both-sided atrophy significantly increased the risk of CCA (hazard ratio, 4.56; 95% confidence interval, 1.48 to 14.09; p=0.008). In 21 patients who developed intrahepatic CCA, the tumor was located mostly in an atrophied lobe (p=0.023). Conclusions: RPC patients frequently developed acute cholangitis, liver abscess, cirrhotic complications, and CCA. Both-sided liver atrophy was significantly associated with an increased risk of CCA.
Keywords: Cholangitis; Prognosis; Atrophy; Cirrhosis; Cholangiocarcinoma
Abstract
Background/Aims: Recurrent pyogenic cholangitis (RPC) is a chronic, progressive disease frequently accompanied by cholangiocarcinoma (CCA). This study aimed to investigate the natural course of RPC and identify factors associated with CCA. Methods: From January 2005 to December 2016, 310 patients with RPC at Seoul National University Hospital were included. Complications and management during follow-up were recorded. CCA-free probability was estimated by the Kaplan-Meier method, and risk factors associated with CCA were analyzed using the log-rank test and Cox proportional hazards regression model. Results: The mean age at diagnosis was 59.1±10.9 years, and the mean follow-up duration was 84.0±64.1 months. An intrahepatic duct stone was found in 253 patients (81.6%). Liver atrophy was identified in 185 patients (59.7%) and was most commonly located at the left lobe (65.4%). Acute cholangitis, liver abscesses, cirrhotic complications, and CCA developed in 41.3%, 19.4%, 9.7%, and 7.4% of patients, respectively. During follow-up, the complete resolution rate after hepatectomy, biliary bypass surgery, and choledocholithotomy with T-tube insertion reached 82.3%, 55.2%, and 42.1%, respectively. None of the patients who maintained complete resolution by the last follow-up day developed CCA. In a univariable analysis, female, both-sided intrahepatic duct stones, and liver atrophy at any location were associated with increased risk of CCA. Multivariable analysis revealed that both-sided atrophy significantly increased the risk of CCA (hazard ratio, 4.56; 95% confidence interval, 1.48 to 14.09; p=0.008). In 21 patients who developed intrahepatic CCA, the tumor was located mostly in an atrophied lobe (p=0.023). Conclusions: RPC patients frequently developed acute cholangitis, liver abscess, cirrhotic complications, and CCA. Both-sided liver atrophy was significantly associated with an increased risk of CCA.
Keywords: Cholangitis; Prognosis; Atrophy; Cirrhosis; Cholangiocarcinoma
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