PROSPECTIVE ANALYSIS OF CLINICAL CHARACTERISTICS AND RISK FACTOR FOR CHOLANGIOCARCINOMA
Cholangiocarcinoma (CCA) is a tumor of the biliary tract, presumably of cholangiocytic origin, with a rising global incidence. The objective of this retrospective cohort study was to develop risk factors of CCA.
Our predictor model was derived from completed data obtained on 4,074 participants (follow-up: 2011-2016) in Ban Luang district, Nan Province of Northern Thailand. Forward stepwise Cox proportional hazard model was applied to obtain coefficients for each predictor. Model input included age, sex, body mass index, cigarette smoking, alcohol consumption, opisthorchis viverrini (OV) infection, antiparasitic drug consumption, occupation, agricultural chemical exposure, family history of CCA in first-degree relatives, calcified bile duct dilatation and fibrosis from abdominal ultrasound, cancer antigen 19-9 (CA19-9), carcinoembryonic antigen (CEA) and alkaline phosphatase (ALP). All statistical tests were two-sided.
During a median follow-up of 50 months, 32 cases of CCA and 19 cases of pre-malignant lesions were newly diagnosed. In the bootstrap simulation (1000 random samplings), family history of CCA in first-degree relatives (HR=1.96), ALP > 100 (HR=2.62) and bile duct dilatation (HR= mild, 4.61, moderate:16.10) were statistically significant independent predictors of CCA risk. The Harrell's C concordance statistic was 0.80.
In conclusion, 6 month ultrasound follow-up is recommended in those with family history of CCA in first-degree relatives, ALP>100 IU/L and bile duct dilatation.