Removal of intrahepatic bile duct stone could reduce the risk of cholangiocarcinoma: A single-center retrospective study in South Korea

doi:10.12998/wjcc.v12.i5.913

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Feb 16, 2024 (publication date) through Jan 11, 2025

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World Journal of Clinical Cases

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Clin Cases. Feb 16, 2024; 12(5): 913-921
Published online Feb 16, 2024. doi: 10.12998/wjcc.v12.i5.913

Table 1 Baseline characteristics between intrahepatic duct stone patient with or without cholangiocarcinoma

Variable	IHD stone with CCC, n = 36	IHD stone without CCC, n = 361	P value
Male sex	12 (33.3)	143 (39.6)	0.461³
Age	60.75 ± 10.20	61.31 ± 10.58	0.687²
BMI	23.27 ± 3.23	22.93 ± 3.27	0.551¹
Hepatitis
None	31 (86.1)	342 (94.7)	0.049⁴
HBV	4 (11.1)	11 (3.0)
HCV	1 (2.8)	8 (2.2)
DM	5 (13.9)	53 (14.7)	0.893³
HT	5 (13.9)	66 (18.4)	0.503³
CA19-9, minimum	176.00 ± 463.47	11.96 ± 15.65	0.010²
CA19-9 > UNL	7 (19.4)	7 (1.9)	< 0.001⁴
CEA, minimum	8.23 ± 29.45	1.96 ± 1.32	0.332²
CEA > UNL	5 (13.9)	7 (1.9)	0.002⁴
Location
Lt & both	31 (86.1)	253 (70.1)	0.042³
Rt	5 (13.9)	108 (29.9)
Multiple stone	30 (83.3)	254 (70.4)	0.100³
Stone size > duct diameter	19 (52.8)	173 (47.9)	0.578³
Focal atrophy	19 (52.8)	97 (26.9)	0.001³
Duct stricture	17 (47.2)	90 (24.9)	0.004³
IHD stone removal	12 (33.3)	228 (63.2)	< 0.001³
Complete removal & no recurrence	8 (22.2)	165 (45.7)	0.007³
Complete removal & recurrence	2 (5.6)	29 (8.0)	10.000⁴
Incomplete removal	2 (5.6)	34 (9.4)	0.759⁴
Removal method
Non-surgery, PTCS, ERCP	6 (50.0)	128 (56.1)	0.676³
Surgery	6 (50.0)	100 (43.9)
Medication
Aspirin	0 (0.0)	14 (3.9)	0.626⁴
UDCA	28 (77.8)	265 (73.4)	0.570³
Metformin	3 (8.3)	19 (5.3)	0.4374
Statin	2 (5.6)	23 (6.4)	1.000⁴
Recurrent cholangitis	20 (55.6)	185 (51.2)	0.622³
F/U period, mean ± SD	96.33 ± 59.06	83.93 ± 60.38	0.164²

¹P values were derived from independent t-test.

²P values were derived from Mann-Whitney U test.

³P values were derived by χ² test.

⁴P values were derived from Fisher’s exact test. Shapiro-Wilk test was employed for test of normality assumption. Values are either frequency with percentage in parentheses or mean ± standard deviation (SD) or median (interquartile range). BMI: Body mass index; CA19-9: Carbohydrate antigen 19-9; CCC: Cholangiocarcinoma; CEA: Carcinoembryonic antigen; DM: Diabetes mellitus; ERCP: Endoscopic retrograde cholangiopancreatography; F/U: Follow up; HBV: Hepatitis B virus; HCV: Hepatitis C virus; IHD: Intrahepatic duct; HT: Hypertension; PTCS: Percutaneous transhepatic cholangioscopy; UDCA: Ursodeoxycholic acid; UNL: Upper normal limit.

Table 2 Risk factor analysis for cholangiocarcinoma

Variable	Univariate analysis			Multivariate analysis
Variable	OR	95%CI	P value	OR	95%CI	P value¹
Male sex	0.76	0.37-1.57	0.463
Age	0.99	0.96-1.03	0.761
BMI	1.03	0.93-1.15	0.550
Hepatitis
None	Reference
HBV	4.01	1.21-13.35	0.023
HCV	1.38	0.17-11.39	0.765
DM	0.93	0.35-2.51	0.893
HT	0.72	0.27-1.91	0.505
CA19-9, minimum	1.01	1.00-1.02	0.013
CA19-9 > UNL	12.21	4.01-37.19	0.000	15.85	3.79-66.31	0.000
CEA, minimum	1.28	1.03-1.59	0.026
CEA > UNL	8.16	2.44-27.21	0.001	8.12	1.87-35.35	0.005
Location, Lt and both	2.65	1.00-6.99	0.049	4.37	1.37-13.94	0.013
Multiple stone	2.11	0.85-5.21	0.107
Stone size > duct diameter	1.21	0.61-2.41	0.579
Focal atrophy	3.04	1.52-6.09	0.002	2.59	1.13-5.94	0.025
Duct stricture	2.69	1.34-5.41	0.005	2.24	0.96-5.23	0.061
IHD stone removal
Complete removal and no recurrence	0.34	0.15-0.76	0.009	0.21	0.09-0.50	0.000
Complete removal and recurrence	0.67	0.15-2.95	0.600
Incomplete removal	0.57	0.13-2.46	0.447
Removal method
None	Reference
Non-surgery, PTCS, ERCP	0.26	0.10-0.66	0.004	0.33	0.07-1.45	0.141
Surgery	0.33	0.13-0.84	0.021	0.37	0.08-1.70	0.200
Medication
Aspirin	0.00	0.00-0.00	0.999
UDCA	1.27	0.56-2.88	0.570
Metformin	1.64	0.46-5.82	0.447
Statin	0.86	0.20-3.83	0.848

¹Effect of independent variables on response variable was analyzed using multivariate logistic regression, and the statistically significant variables were included in the univariate logistic regression with 0.05 alpha level. BMI: Body mass index; CA19-9: Carbohydrate antigen 19-9; CEA: Carcinoembryonic antigen; CI: Confidence interval; DM: Diabetes mellitus; ERCP: Endoscopic retrograde cholangiopancreatography; HBV: Hepatitis B virus; HCV: Hepatitis C virus; HT: Hypertension; IHD: Intrahepatic duct; OR: Odds ratio; PTCS: Percutaneous transhepatic cholangioscopy; UNL: Upper normal limit; UDCA: Ursodeoxycholic acid.

Table 3 Comparison of results according to stone removal method, n = 240

Removal method	Surgery, n = 106	Non-surgery, n = 134	P value
Cholangiocarcinoma	6 (5.7)	6 (4.5)	0.676
Remnant stone	9 (8.5)	27 (20.1)	0.012
Recurrent stone	12 (11.3)	52 (38.8)	< 0.001
Recurrent cholangitis	37 (34.9)	96 (71.6)	< 0.001

Citation: Kim TI, Han SY, Lee J, Kim DU. Removal of intrahepatic bile duct stone could reduce the risk of cholangiocarcinoma: A single-center retrospective study in South Korea. World J Clin Cases 2024; 12(5): 913-921
URL: https://www.wjgnet.com/2307-8960/full/v12/i5/913.htm
DOI: https://dx.doi.org/10.12998/wjcc.v12.i5.913