title: High serum CA19-9 levels are associated with an increased risk of cholangiocarcinoma in patients with intrahepatic duct stones: a case-control study.
abstract: BACKGROUND
  Hepatolithiasis is a known risk factor for cholangiocarcinoma (CC). Due to the high risk of complications that accompany endoscopic and surgical stone removal, it is often difficult to decide whether it is beneficial to remove intrahepatic ductal stones. We conducted a case-control study to determine the risk of developing CC and the benefit of stone removal in patients with hepatolithiasis.
  
  
  METHODS
  Twenty-three patients with CC group between 2002 and 2012 were included in this study. For each patient with CC, four control patients with hepatolithiasis were enrolled based on age and sex matching. Finally, 115 patients with hepatolithiasis were enrolled.
  
  
  RESULTS
  The mean length of time that intrahepatic stones were present was 116.57 (± 98.77) months in the CC group and 80.56 (± 101.10) months in the control group. History of gastrectomy [OR 5.756 (1.329-24.930), p = 0.019], history of choledochoenterostomy (OR 4.938 [1.129-21.595], p = 0.034), serum CA19-9 level [OR 1.001 (1.000-1.001), p = 0.022], and complete removal of stones [OR 0.167 (0.052-0.539), p = 0.003] were independent predictive factors of CC. In patients who had undergone incomplete removal of stones, the occurrence of CC was significantly reduced overall as well as in a subgroup of patients with elevated CA19-9 (p = 0.015 and p = 0.006, respectively) compared to patients with a CA19-9 of <22 U/mL (p = 0.477).
  
  
  CONCLUSIONS
  History of gastrectomy or choledochoenterostomy, high levels of serum CA19-9, and incomplete removal of stones were potential predictive factors of CC in patients with hepatolithiasis. Additionally, complete removal of stones may reduce the risk of CC in patients with high serum CA19-9 levels (>22 U/mL).
authors.affiliation: Department of Internal Medicine, Institute of Gastroenterology, Yonsei University Health System, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea.
authors.forename: Jung Hyun
authors.initials: JH
authors.lastname: Jo
authors.forename: Moon Jae
authors.initials: MJ
authors.lastname: Chung
authors.forename: Jeong Youp
authors.initials: JY
authors.lastname: Park
authors.forename: Seungmin
authors.initials: S
authors.lastname: Bang
authors.forename: Seung Woo
authors.initials: SW
authors.lastname: Park
authors.forename: Kyung Sik
authors.initials: KS
authors.lastname: Kim
authors.forename: Woo Jung
authors.initials: WJ
authors.lastname: Lee
authors.forename: Si Young
authors.initials: SY
authors.lastname: Song
authors.forename: Jae Bock
authors.initials: JB
authors.lastname: Chung
mesh_terms: D015295:Antigens, Tumor-Associated, Carbohydrate / Q000097:blood*; D001650:Bile Duct Neoplasms / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology*; D001653:Bile Ducts, Intrahepatic; D014408:Biomarkers, Tumor / Q000097:blood*; D016022:Case-Control Studies; D015984:Causality; D018281:Cholangiocarcinoma / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology*; D015897:Comorbidity; D005260:Female; D042882:Gallstones / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors
chemical_list: D015295:Antigens, Tumor-Associated, Carbohydrate; D014408:Biomarkers, Tumor; C578959:carbohydrate antigen 199, human