Clinicopathological Characteristics And Survival Analysis Of Hepatolithiasis Associated With Intrahepatic Cholangiocarcinoma

Objective:To investigate the relationship between intrahepatic stones and intrahepatic cholangiocarcinoma, we retrospectively analysed the clinicopathological characteristics of hepatolithiasis associated with intrahepatic cholangiocarcinoma and underwent survival analysis to clarify the outcomes and prognostic factors.Methods:From July2006to September2009, a total of36surgical resections for hepatolithiasis associated with intrahepatic cholangiocarcinoma confirmed by pathology were performed at Shandong University Qilu hospital. Those who diagnosed with hepatocellular carcinoma, mixed carcinoma, hepatolithiasis with atypical hyperplasia and intrahepatic cholangiocarcinoma were excluded. Then we collected the information of the remaining patients, including general information, blood test, imaging data and pathological characteristics. Subsequently, we performed survival analysis according to the outcome.Results:1. Of the36patients,13were male and23were female with a mean age of57.5years (range,36-82years). The history of intrahepatic stones was11years ranged from6to20. The most common clinical manifestations were recurrent Charcot triad (n=21) and obstructive jaundice (n=6). 2. Blood test showed that white blood cell count was not less than10X109/L in23patients, serum carbohydrate antigen19-9level was more than182U/ml in21patients, serum fetoprotein level was more than25ug/L in5patients and serum carcinoma embryonic antigen level was more5ug/ml in16patients. All the patients underwent abdominal doppler ultrasound revealed that multiple stones located in the dilated bile duct and a changed echo emerged which suspected occupying lesion. Furthermore, abnormal soft tissue density and signal were found across the dilated bile ducts in CT and MRI.3. The classification of macroscopic type of the excised tumor were as follows:MF type (18/36), PI type (9/36), and IG type (9/36). Moderately-poorly differentiated adenocarcinoma was the most common histopathological finding. Surgical margin less than10millimetre was found in20patients. Immunohistochemistry showed CK7and CK19positive in six patients and CK20positive in three patients.4. The median survival period was21.4month in31patients whose survival data were available and the cumulative1-,3, and5-year survival rates were63.6%.36.4%, and30.3%, respectively. To the patients with curative resection, the cumulative1-,3, and5-year survival rates were higher than those underwent palliative resection, with about81.4%,61.7%, and58.6%, respectively. Serum CA19-9and surgical margin were the significant prognostic factors by log-rank test and Cox proportional hazards regression model.Conclusions:1. To the patients with hepatolithiasis, when the history was more than eleven years, recurrent cholangitis (Charcot triad) emerged recently, serum CA19-9level elevated and abnormal soft tissue density or signal appeared in the dilated bile duct in CT or MRI, we should highly suspected the generation of intrahepatic cholangiocarcinoma.2. Curative liver resection was known to be the most effective therapeutic measure. 3. MF type and moderately-poorly differentiated adenocarcinoma were the most common histopathological findings. CK7and CK19could be uesfull for the pathological diagnosis of intrahepatic cholangiocarcinoma.4. Serum CA19-9level was a valuable clinical factor for predicting survive and an adequate surgical margin was the modifiable factor by a surgeon during liver resection for hepatolithiasis associated with intrahepatic cholangiocarcinoma.