Risk factors for preoperative carcinogenesis of bile duct cysts in adults

Table 1 Demographic data, symptoms, and laboratory test findings for patients with bile duct cyst

	Overall cohort (n = 109)	Group A (n = 99)	Group B (n = 10)	P value
Male/female (n)	19/90	19/80	0/10	0.277
Age at symptom onset (yr)	34.6 ± 15.5	34.7 ± 15.4	34.0 ± 16.5	0.892
Age at admission (yr)	40.4 ± 15.0	40.6 ± 15.0	38.1 ± 16.0	0.611
BMI (kg/m2)	22.0 ± 3.3	22.1 ± 3.4	21.6 ± 2.2	0.634
Smoking (n)	7	7	0	1.000
Abdominal pain (n)	90	82	8	1.000
Fever (n)	29	26	3	1.000
Jaundice (n)	14	11	3	0.228
CA19-9 > 34 U/mL (n)	9	8	1	0.594
CEA > 5 ng/mL (n)	1	0	1	0.092
APBD (n)	55	51	4	0.717

BMI: Body mass index; CA19-9: Carbohydrate antigen 19-9; CEA: Carcinoembryonic antigen; APBD: Abnormal pancreatic biliary duct.

Table 2 Stratified analysis for association between age and dysplasia/carcinoma rates

Age (yr)	Total, n	Dysplasia/carcinoma, n (%)	P value
18-30	35	4 (11.4)	0.866
31-40	21	2 (9.5)
41-50	24	2 (8.3)
51-60	13	0 (0)
≥ 61	16	2 (12.5)

Table 3 Operation details, pathology information, and Todani types for patients with bile duct cyst

	Overall cohort (n = 109)	Group A (n = 99)	Group B (n = 10)	P value
Operative time (min)	219.2 ± 64.8	215.8 ± 61.6	249.5 ± 86.6	0.119
Bleeding amount (mL)	212.3 ± 210.0	204.8 ± 202.0	283.0 ± 277.5	0.265
Max diameter of GB (cm)	7.8 ± 1.7	7.9 ± 1.7	7.0 ± 1.7	0.147
GB wall thickness > 0.3 cm (n)	20	15	5	0.022
TD of cyst > 3 cm (n)	46	38	8	0.028
Cyst wall thickness > 0.3 cm (n)	8	8	0	1.000
Bile duct stone (n)	22	21	1	0.668
Todani classification (n)1				0.031
I	74	71	3
III	1	1	0
IVa	31	24	7
V	3	3	0

¹There was no patient with Todani type II or IVb.

GB: Gallbladder; TD: Transverse diameter.

Table 4 Multivariate analysis for risk factors for preoperative carcinogenesis of bile duct cyst

	P value	OR	95%CI
Gallbladder wall thickness > 0.3 cm	0.020	6.551	1.351-31.763
Todani type IV	0.011	7.675	1.584-37.192
Transverse diameter of cyst > 3 cm	0.051	5.479	0.990-30.333

OR: Odds ratio; CI: Confidence interval.

Table 5 Clinical data of ten bile duct cyst patients with dysplasia or carcinoma

No.	Sex	Age (yr)	Todani type	Operation	Lesion location	Pathology	TNM stage1	Follow-up time (mo)	Outcome
1	F	39	IVa	CH + CE + HJ	Cyst	Mucinous adenocarcinoma	T4N0M0	40	Recurred 10 mo after surgery, alive with tumor
2	F	46	IVa	CH + CE + HJ	Gallbladder	Mucinous adenocarcinoma	T3N0M0	6	Survived disease free for 6 mo after surgery, then lost to follow-up
3	F	44	IVa	CH + CE + HJ	Cyst	Moderate dysplasia	--	52	Disease-free survival
4	F	26	IVa	CH + CE + HJ	Cyst + gallbladder	Mild dysplasia	--	53	Disease-free survival
5	F	61	I	CH + CE + HJ	Gallbladder	Adenocarcinoma	T2N0M0	40	Disease-free survival
6	F	27	IVa	CH + CE + HJ	Cyst + gallbladder	Moderate dysplasia	--	66	Disease-free survival
7	F	33	IVa	Pancreaticoduodenectomy	Cyst	Adenocarcinoma	TisN0M0	81	Disease-free survival
8	F	18	I	CH + CE + HJ	Cyst + gallbladder	Mild dysplasia	--	40	Disease-free survival
9	F	65	I	CH + CE + HJ	Gallbladder	Adenocarcinoma	T1N0M0	65	Disease-free survival
10	F	22	IVa	CH + CE + HJ	Cyst	Mild dysplasia	--	--	Lost to follow-up

¹Staging was according to the American Joint Committee on Cancer 8^th 2018 Tumor Node Metastasis classification.

CH: Cholecystectomy; CE: Cyst excision; HJ: Hepaticojejunostomy; TNM: Tumor node metastasis.