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Screening and surveillance for occupational cholangiocarcinoma in workers exposed to organic solvents

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Abstract

Purpose

This study aimed to establish an efficient strategy for screening and surveillance for occupational cholangiocarcinoma.

Methods

We evaluated the consecutive changes in laboratory findings during regular health examinations and in abdominal ultrasonography findings before the diagnosis of occupational cholangiocarcinoma in nine patients. The results of laboratory tests and abdominal ultrasonography at the time of diagnosis were also examined.

Results

In all patients, the serum γ-glutamyl transpeptidase (γ-GTP) activity increased several years before the diagnosis of cholangiocarcinoma. The serum alanine aminotransferase (ALT) activity also increased several years before the diagnosis, following an increase in the serum aspartate aminotransferase (AST) activity in most patients. Abdominal ultrasonography before the diagnosis revealed regional dilatation of the bile ducts, which continued to enlarge. At the time of diagnosis, the γ-GTP, AST, and ALT activities were increased in nine, seven, and seven patients, respectively. The regional dilatation of bile ducts without tumor-induced stenosis, dilated bile ducts due to tumor-induced stenosis, space-occupying lesions, and/or lymph node swelling were observed. The serum concentrations of carbohydrate antigen 19-9 (CA 19-9) and/or carcinoembryonic antigen (CEA) were increased in all patients.

Conclusions

Regular health examinations with a combination of ultrasonography and laboratory tests including the γ-GTP, AST, ALT, CA 19-9, and CEA levels are useful for screening and surveillance for occupational cholangiocarcinoma.

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Abbreviations

γ-GTP:

γ-Glutamyl transpeptidase

ALT:

Alanine aminotransferase

AST:

Aspartate aminotransferase

CA19-9:

Carbohydrate antigen 19-9

CEA:

Carcinoembryonic antigen

DCM:

Dichloromethane

DCP:

1,2-Dichloropropane

PSC:

Primary sclerosing cholangitis

MRI:

Magnetic resonance imaging

MRCP:

Magnetic resonance cholangiopancreatography

ERCP:

Endoscopic retrograde cholangiopancreatography

References

  1. Kumagai S, Kurumatani N, Arimoto A, Ichihara G. Cholangiocarcinoma among offset colour proof-printing workers exposed to 1,2-dichloropropane and/or dichloromethane. Occup Environ Med. 2013;70:508–10.

    Article  CAS  PubMed  Google Scholar 

  2. Kubo S, Nakanuma Y, Takemura S, Sakata C, Urata Y, Nozawa A, et al. Case series of 17 patients with cholangiocarcinoma among young adult workers of a printing company in Japan. J Hepatobiliary Pancreat Sci. 2014;21:479–88.

    Article  PubMed  Google Scholar 

  3. Ministry of Health, Labour and Welfare. Occupational biliary tract cancer cases in Japan. http://www.mhlw.go.jp/english/policy/employ-labour/labour-standards/Occupational.html.

  4. Kubo S, Kinoshita M, Takemura S, Tanaka S, Shinkawa H, Nishioka T, et al. Characteristics of printing company workers newly diagnosed with occupational cholangiocarcinoma. J Hepatobiliary Pancreat Sci. 2014;21:479–88.

    Article  PubMed  Google Scholar 

  5. Ikai I, Kudo M, Arii S, Omata M, Kojiro M, Sakamoto M, et al. Report of the 18th follow-up survey of primary liver cancer in Japan. Hepatol Res. 2010;40:1043–59.

    Article  Google Scholar 

  6. Miyakawa S, Ishihara S, Horiguchi A, Takada T, Miyazaki M, Nagakawa T. Biliary tract cancer treatment: 5,584 results from the biliary tract cancer statistics registry from 1998 to 2004 in Japan. J Hepatobiliary Pancreat Surg. 2009;16:1–7.

    Article  PubMed  Google Scholar 

  7. Uchiyama K, Yamamoto M, Yamaue H, Ariizumi S, Aoki T, Kokudo N, et al. Impact of nodal involvement on surgical outcomes of intrahepatic cholangiocarcinoma: a multicenter analysis by the Study Group foe Hepatic Surgery of the Japanese Society of Hepato-Biliary-Pancreatic Surgery. J Hepatobiliary Pancreat Sci. 2011;18:443–52.

    Article  PubMed  Google Scholar 

  8. Uenishi T, Ariizumi S, Aoki T, Ebata T, Ohtsuka M, Tanaka E, et al. Proposal of a new staging system for mass-forming intrahepatic cholangiocarcinoma: a multicenter analysis by the Study Group for Hepatic Surgery of the Japanese Society of Hepato-Biliary-Pancreatic Surgery. J Hepatobiliary Pancreat Sci. 2014;21:499–508.

    Article  PubMed  Google Scholar 

  9. Kamphues C, Al-Abadi N, Dürr A, Bova R, Klauschen F, Stenzinger A, et al. The DNA index is a strong predictive marker in intrahepatic cholangiocarcinoma: the results of a five-year prospective study. Surg Today. 2014;44:1336–42.

    Article  CAS  PubMed  Google Scholar 

  10. Murakami S, Ajiki T, Okazaki T, Ueno K, Kido M, Matsumoto I, et al. Factors affecting survival after resection of intrahepatic cholangiocarcinoma. Surg Today. 2014;44:1847–54.

    Article  PubMed  Google Scholar 

  11. Kubo S, Takemura S, Sakata C, Urata Y, Nishioka T, Nozawa A, et al. Changes in laboratory test results and diagnostic imaging presentation before the detection of occupational cholangiocarcinoma. J Occup Health. 2013;56:317–22.

    Article  Google Scholar 

  12. Kumagai S, Kurumatani N, Arimoto A, Ichihara G. Time course of blood parameters in printing workers with cholangiocarcinoma. J Occup Health 2014;56:279-84.

  13. Sato Y, Kubo S, Takemura S, Sugawara Y, Tanaka S, Fujikawa M, et al. Different carcinogenic process in cholangiocarcinoma cases epidemically developing among workers of a printing company in Japan. Int J Clin Exp Pathol. 2014;7:4745–54.

    PubMed  PubMed Central  Google Scholar 

  14. Patel AH, Harnois DM, Klee GG, LaRusso NF, Gores GJ. The utility of CA 19-9 in the diagnoses of cholangiocarcinoma in patients without primary sclerosing cholangitis. Am J Gastroenterol. 2000;95:204–7.

    Article  CAS  PubMed  Google Scholar 

  15. Uenishi T, Kubo S, Hirohashi K, Tanaka H, Shuto T, Yamamoto T, et al. Cytokeratin-19 fragments in serum (CYFRA 21-1) as a marker in primary liver cancer. Br J Cancer. 2003;88:1894–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Qin XL, Wang ZR, Shi JS, Lu M, Wang L, He QR. Utility of serum CA 19-9 in diagnosis of cholangiocarcinoma: in comparison with CEA. World J Gastroenterol. 2004;10:427–32.

    PubMed  PubMed Central  Google Scholar 

  17. Nichols JC, Gores GJ, LaRusso NF, Wiesner RH, Nagorney DM, Ritts RE Jr. Diagnostic role of serum CA 19-9 for cholangiocarcinoma in patients with primary sclerosing cholangitis. Mayo Clin Proc. 1993;68:874–9.

    Article  CAS  PubMed  Google Scholar 

  18. Ramage JK, Donaghy A, Farrant JM, Iorns R, Williams R. Serum tumor markers for the diagnosis of cholangiocarcinoma in primary sclerosing cholangitis. Gastroenterology. 1995;108:865–9.

    Article  CAS  PubMed  Google Scholar 

  19. Chalasani N, Baluyut A, Ismail A, Zaman A, Sood G, Ghalib R, et al. Cholangiocarcinoma in patients with primary sclerosing cholangitis: a multicenter case-control study. Hepatology. 2000;31:7–11.

    Article  CAS  PubMed  Google Scholar 

  20. Charatcharoenwitthaya P, Enders FB, Halling KC, Lindor KD. Utility of serum tumor markers, imaging, and biliary cytology for detecting cholangiocarcinoma in primary sclerosing cholangitis. Hepatology. 2008;48:1106–17.

    Article  CAS  PubMed  Google Scholar 

  21. Watanabe T, Hirano K, Tada M, Isayama H, Mizuno S, Arizumi T, et al. Short-term prognostic factors for primary sclerosing cholangitis. J Hepatobiliary Pancreat Sci. 2015;22:486–90.

    Article  PubMed  Google Scholar 

  22. Kubo S, Kinoshita H, Hirohashi K, Hamba H. Hepatolithiasis associated with cholangiocarcinoma. World J Surg. 1995;19:637–41.

    Article  CAS  PubMed  Google Scholar 

  23. Kim YT, Byun JS, Kim J, Jang YH, Lee WJ, Ryu JK, et al. Factors predicting concurrent cholangiocarcinomas associated with hepatolithiasis. Hepatogastroenterology. 2003;50:8–12.

    PubMed  Google Scholar 

  24. Razumilava N, Gores GJ, Lindor KD. Cancer surveillance in patients with primary sclerosing cholangitis. Hepatology. 2011;54:1842–52.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Berquist A, Ekbom A, Olsson R, Kornfeldt D, Lööf L, Danielsson A, et al. Hepatic and extrahepatic malignancies in primary sclerosing cholangitis. J Hepatol. 2002;36:321–7.

    Article  Google Scholar 

  26. Burak K, Angulo P, Pasha TM, Egan K, Petz J, Lindor KD. Incidence and risk factors for cholangiocarcinoma in primary sclerosing cholangitis. Am J Gastroenterol. 2004;99:523–6.

    Article  PubMed  Google Scholar 

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Acknowledgments

This study was supported in part by the Health and Labor Sciences Research Grants for Research on Occupational Safety and Health (The epidemiological and cause-investigated study of cholangiocarcinoma in workers of a printing company) and by the Industrial Disease Clinical Research Grants (Establishment of diagnostic methods for occupational cholangiocarcinoma; 14040101-01). This work was also supported in part by the Japan Society for the Promotion of Science (JSPS) KAKENHI Grant Number 26245678 (Clinicopathological and molecular biological analysis of carcinogenesis of intrahepatic cholangiocarcinoma by chemicals). The authors thank Drs. Y. Matsumura, S. Marubashi and T. Yamada for their assistance and for collecting the patient’s data.

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Correspondence to Shoji Kubo.

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Shoji Kubo and co-authors have no conflicts of interest.

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Kubo, S., Takemura, S., Tanaka, S. et al. Screening and surveillance for occupational cholangiocarcinoma in workers exposed to organic solvents. Surg Today 46, 705–712 (2016). https://doi.org/10.1007/s00595-015-1229-9

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  • DOI: https://doi.org/10.1007/s00595-015-1229-9

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