Cholangiocarcinoma in liver cirrhosis.
OBJECTIVE
Hepatocellular carcinoma (HCC) is usually associated with chronic liver diseases and liver cirrhosis, while conversely, cholangiocarcinoma (CC) usually occurs in a non-cirrhotic liver. The purpose of the present study was to evaluate CC in liver cirrhosis.


METHODS
Between January 1998 and December 1999, 26 patients with CC were retrospectively reviewed. The occurrence of CC in chronic hepatitis B infection-related liver cirrhosis, portal vein thrombosis (PVT) and survival were analyzed.


RESULTS
Twenty-six patients with CC (19 with a non-cirrhotic liver and seven with chronic hepatitis B infection-related liver cirrhosis) were included in the present study. All cases of CC in the cirrhotic group were incidentally discovered during routine screening for HCC. The mean age (+/- SD) was 58.8 +/- 14 years in the cirrhotic group and 73.2 +/- 15.9 years (P = 0.001) in the non-cirrhotic group. When compared to the cirrhotic group, the non-cirrhotic group had a higher median level of albumin (42 compared to 30 g/L, P = 0.005), bilirubin (117.5 compared to 18 micro mol/L, P = 0.01), alkaline phosphatase (291.5 compared to 100 U/L, P = 0.001) and gamma glutamyl transpeptidases (215.5 compared to 31 U/L, P = 0.001). In contrast, the cirrhotic group had a higher median prothrombin time (PT) compared to the non-cirrhotic group (18.2 compared to 12 s, P = 0.05). In the non-cirrhotic group, only one patient (5.3%) showed evidence of PVT on a computerized tomography and Doppler ultrasound, while in the cirrhotic group six patients (85.7%) had PVT (P < 0.001). The median survival period in the cirrhotic group was six months (range 2-24 months) compared to 16 months (range 6-41 months) in the non-cirrhotic group (P = 0.036).


CONCLUSIONS
CC in cirrhotic liver presented at a younger age and patients who developed CC were prone to PVT. The survival period was also shorter in comparison to that of non-cirrhotic liver patients.
Hui
Chee-Kin
CK
Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
Yuen
Man-Fung
MF
Tso
Wai-Kuen
WK
Ng
Irene Oi-Lin
IO
Chan
Annie On-On
AO
Lai
Ching-Lung
CL
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage; D001650:Bile Duct Neoplasms / Q000150:complications* / Q000401:mortality / Q000628:therapy; D001653:Bile Ducts, Intrahepatic / Q000000981:diagnostic imaging / Q000473:pathology*; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D016461:Chemoembolization, Therapeutic; D018281:Cholangiocarcinoma / Q000150:complications* / Q000401:mortality / Q000628:therapy; D002760:Cholangiopancreatography, Endoscopic Retrograde; D005260:Female; D006723:Hong Kong; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011517:Prothrombin Time; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D000509:alpha-Fetoproteins / Q000378:metabolism
D000970:Antineoplastic Agents; D015415:Biomarkers; D000509:alpha-Fetoproteins