Risk Factor Analysis And Diagnostic Modeling Of Hepatolithiasis-associated Intrahepatic Cholangiocarcinoma

Objective: A retrospective analysis of patients with hepatolithiasis-associated intrahepatic cholangiocarcinoma versus patients with hepatolithiasis was performed in order to identify risk factors for HL-CCA,and to compare the traditional diagnostic way CA199,CEA,CA125,and contrast-enhanced CT with the new indices CYFRA211,CA242,S-index,Fib-4,NLR,and PLR for its diagnostic efficacy.Methods: Patients who attended the hospital between January 2015 and July 2022 with imaging suggestive of hepatolithiasis with tumor and underwent surgery or liver tissue biopsy were retrospectively analyzed,and patients were divided into CCA group and benign lesion group.The diagnostic efficacy was assessed by comparing the general characteristics and imaging and laboratory indices of the two groups by independent sample t-test,u-test or chi-square test,and the indices with significant differences(p>0.05)were used as diagnostic methods.The better indicators were included in the logistic regression equation to derive the equation of the combined diagnostic model.Results: A total of 119 cases of hepatolithiasis with tumors were included in the study,including 59 cases in the CCA group and 60 cases in the benign lesion group.Univariate analysis of gender composition,body mass index,time of first stone consultation,history of hepatitis B,diabetes and hypertension,location of intrahepatic bile duct stones,liver atrophy,and preoperative total bilirubin level were not significantly different between the two groups(p>0.05),nor were preoperative PLR levels and two liver fibrosis index levels(p>0.05);the mean age of patients with HLCCA was 62.2±9.7 years.Among them,33 patients(55.9%)had a history of recurrent bile duct stones,28(47.5%)were diagnosed malignant with contrast-enhanced CT,CA199 93.66(20.09,419.21)U/ml,CA125 27.99(14.75,54.67)U/ml,CEA 3.48(1.61,22.38)ng/ml,CYFRA211 2.61(1.5,4.84)ng/ml;mean age of patients with benign lesions 56.4±9.6 years,including 19 patients(31.7%)with a history of recurrent bile duct stones,14 patients(23.3%)diagnosed malignant with contrast-enhanced CT,CA199 32.12(14.78,136.40)U/ml,CA125 13.27(9.70,19.11)U/ml,CEA 1.4(0.76,2.20)ng/ml,CYFRA211 0.86(0.71,1.78)ng/ml;HL-CCA was associated with advanced age,history of recurrent bile duct stones,malignant presentation on contrastenhanced CT,and upraise of CA199,CA125,CEA,CYFRA211 and NLR(P<0.05).The diagnostic efficacy of the above indicators as individual diagnosis is the best for the six parameters of age,history of recurrent gallstones,CA 199,CA 125,CEA and CYFRA 211,and after being included in the logistic regression equation,the results of age,CA 125 and CYFRA 211 had the most significant influence on the equation.With these three indicators we made a combined diagnosis model,and the AUC value of this diagnosis model was higher than all the above indicators.Diagnosis model vs CYFRA211 difference between AUC was 0.049(95%CI-0.099～0.106),the diagnostic efficiency may same(P>0.05).Diagnosis model vs Age difference between AUC was0.139(95%CI 0.055～0.222),the model efficiency may better(P<0.05).Diagnosis model vs CA125 difference between AUC was Diagnosis model vs Age difference between AUC was 0.139(95%CI 0.055～0.222),the model efficiency may better(P<0.05),the model efficiency also better(P<0.05).which means the model could be a more efficient diagnosis way for HL-CCA.Conclusions: The diagnostic efficacy of CYFRA211 and CA242 in the diagnosis of HL-CCA are better than the traditional diagnostic indexes,and may be a useful tool for future diagnosis and differential diagnosis.The combination of age,CA125,and CYFRA211 is an effective diagnostic model for HL-CCA.