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High serum CA19-9 levels are associated with an increased risk of cholangiocarcinoma in patients with intrahepatic duct stones: a case–control study

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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).

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Disclosures

Jung Hyun Jo, Moon Jae Chung, Jeong Youp Park, Seungmin Bang, Seung Woo Park, Kyung Sik Kim, Woo Jung Lee, Si Young Song, and Jae Bock Chung have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Internal Medicine, Institute of Gastroenterology, Yonsei University Health System, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea

    Jung Hyun Jo, Moon Jae Chung, Jeong Youp Park, Seungmin Bang, Seung Woo Park, Si Young Song & Jae Bock Chung

  2. Department of Surgery, Yonsei University Health System, Seoul, Republic of Korea

    Kyung Sik Kim & Woo Jung Lee

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  1. Jung Hyun Jo
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  2. Moon Jae Chung
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  9. Jae Bock Chung
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Correspondence to Moon Jae Chung.

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Jo, J.H., Chung, M.J., Park, J.Y. et al. High serum CA19-9 levels are associated with an increased risk of cholangiocarcinoma in patients with intrahepatic duct stones: a case–control study. Surg Endosc 27, 4210–4216 (2013). https://doi.org/10.1007/s00464-013-3025-1

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  • DOI: https://doi.org/10.1007/s00464-013-3025-1

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