title: Clinical significance of isolated biliary candidiasis in patients with unresectable cholangiocarcinoma.
abstract: BACKGROUND
  The frequency of isolated biliary candidiasis is increasing in cancer patients. The clinical significance of isolated biliary candidiasis remains unclear. We analyzed the risk factors of biliary candidiasis and outcomes of the patients with unresectable cholangiocarcinoma after percutaneous transhepatic biliary drainage (PTBD).
  
  
  METHODS
  Among 430 patients who underwent PTBD between January 2012 and March 2015, 121 patients had unresectable cholangiocarcinoma. Bile and blood samples were collected for consecutive fungal culture.
  
  
  RESULTS
  The study cohort included 49 women and 72 men with a median age of 71 years. Multivariate analysis showed that cancer progression (P=0.013), concurrent presence of another microorganism (P=0.010), and previous long-term (>7 days) antibiotic use (P=0.011) were potential risk factors of biliary candidiasis. Chemotherapy was not associated with overall biliary candidiasis (P=0.196), but was significantly related to repeated biliary candidiasis (P=0.011). Patients with isolated biliary candidiasis showed remarkably reduced survival compared with those without [median overall survival (OS): 32 vs 62 days, P=0.011]. Subgroup analysis was also performed. Patients with repeated candidiasis had markedly decreased survival compared with those with transient candidiasis (median OS: 30 vs 49 days, P=0.046). Biliary candidiasis was identified as a poor prognostic factor by univariate and multivariate analyses (P=0.033). Four cases of repeated candidiasis (4/19, 21%) showed Candida species in consecutive blood culture until the end of the study, but others showed no candidemia.
  
  
  CONCLUSIONS
  Isolated biliary candidiasis may be associated with poor prognosis in patients with unresectable cholangiocarcinoma. Especially, repeated biliary candidiasis may have the possibility of progression to candidemia. We suggest that biliary dilatation treatment or antifungal agents might be helpful for patients with biliary candidiasis.
authors.affiliation: Departments of Internal Medicine, Division of Medical Oncology, and Department of Hepato-Biliary-Pancreatic Cancer Center, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea. angelamd@catholic.ac.kr.
authors.forename: In-Ho
authors.initials: IH
authors.lastname: Kim
authors.forename: Jae-Ki
authors.initials: JK
authors.lastname: Choi
authors.forename: Dong-Gun
authors.initials: DG
authors.lastname: Lee
authors.forename: In Seok
authors.initials: IS
authors.lastname: Lee
authors.forename: Tae Ho
authors.initials: TH
authors.lastname: Hong
authors.forename: Young Kyoung
authors.initials: YK
authors.lastname: You
authors.forename: Ho Jong
authors.initials: HJ
authors.lastname: Chun
authors.forename: Myung Ah
authors.initials: MA
authors.lastname: Lee
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D002177:Candidiasis / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000628:therapy*; D016009:Chi-Square Distribution; D018281:Cholangiocarcinoma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D015897:Comorbidity; D004322:Drainage / Q000379:methods*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents