title: Predictive Factors of Biliary Tract Cancer in Anomalous Union of the Pancreaticobiliary Duct.
abstract: The assessment of malignancies associated with anomalous union of the pancreaticobiliary duct (AUPBD) is essential for the design of appropriate treatment strategies. The aim of the present study is to measure the incidence of AUPBD-related pancreaticobiliary malignancy and to identify predictive factors. This retrospective cohort study included cases of 229 patients with AUPBD between January 1999 and December 2013. The impact of bile duct dilatation on the incidence of AUPBD-related pancreaticobiliary disease was measured, and predictive factors were evaluated.Among 229 patients with AUPBD, 152 had common bile duct dilatation (≥10 mm) (dilated group) and 77 did not (<10 mm) (nondilated group). Intrahepatic cholangiocarcinoma occurred more frequently in the nondilated group than in the dilated group (3.9% vs 0%; P < 0.05). By contrast, no significant difference in the incidence of extrahepatic cholangiocarcinoma was observed between the 2 groups (1.3% vs 3.9%; P = 0.271). By univariate analysis, age, type of AUPBD, and the level of pancreatic enzymes refluxed in the bile duct were associated with occurrence of biliary tract cancers. In multivariate analysis, age ≥45 years (odds ratio [OR] 1.042, 95% confidence interval [CI] 1.011-1.073, P < 0.05), P-C type (OR 3.327, 95% CI 1.031-10.740, P < 0.05), and a high level of biliary lipase (OR 4.132, 95% CI 1.420-12.021, P < 0.05) showed a significant association with AUPBD-related biliary tract cancer.Intrahepatic cholangiocarcinoma may occur more frequently in AUPBD patients without bile duct dilatation. Age ≥45 years, P-C type, and biliary lipase level ≥45,000 IU/L are significantly associated with AUPBD-related biliary tract cancer.
authors.affiliation: From the Digestive Disease Center (J-SP), Department of Internal Medicine, Inha University School of Medicine, Incheon; Division of Gastroenterology (TJS, TYP, DO, DHP, SSL, DWS, SKL, M-HK), Asan Medical Center, University of Ulsan College of Medicine, Seoul; and Department of Internal Medicine (HKL), Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea.
authors.forename: Jin-Seok
authors.initials: JS
authors.lastname: Park
authors.forename: Tae Jun
authors.initials: TJ
authors.lastname: Song
authors.forename: Tae Young
authors.initials: TY
authors.lastname: Park
authors.forename: Dongwook
authors.initials: D
authors.lastname: Oh
authors.forename: Hyun Kyo
authors.initials: HK
authors.lastname: Lee
authors.forename: Do Hyun
authors.initials: DH
authors.lastname: Park
authors.forename: Sang Soo
authors.initials: SS
authors.lastname: Lee
authors.forename: Dong Wan
authors.initials: DW
authors.lastname: Seo
authors.forename: Sung Koo
authors.initials: SK
authors.lastname: Lee
authors.forename: Myung-Hwan
authors.initials: MH
authors.lastname: Kim
mesh_terms: D000328:Adult; D000367:Age Factors; D001646:Bile / Q000737:chemistry; D001650:Bile Duct Neoplasms / Q000453:epidemiology*; D001652:Bile Ducts / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000473:pathology*; D018281:Cholangiocarcinoma / Q000453:epidemiology*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D004108:Dilatation, Pathologic / Q000000981:diagnostic imaging; D005260:Female; D005706:Gallbladder Neoplasms / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008049:Lipase / Q000032:analysis; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts / Q000002:abnormalities* / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D008049:Lipase