담도암에 대한 임상적 고찰

안수열,임학,문미경,최영식,차태준,서승연,구자영,박병채 대한내과학회 1992 대한내과학회지 Vol.42 No.2

We assessed 79 cases of chloangiocarcinoma which was diagnosed histologically at Kosin General Hospital and Kim Hae Gospel Hospital from 1986 to 1990 and the results are as follows; 1) More than half of all patients were beyond sixth decade, the ratio of male to female was 2:l and 2.8:1 in intra and extrahepatic cholangiocarcinoma, respectively. 2) Prevalence rate of clonorchiasis was 30%, 18.4% in intrahepatic and extrahepatic cholangiocarcinoma, respectively, and prevalence rate of clonorchiasis in intrahepatic cholangiocarcinoma was markedly higher than that (19.6%) of general population in Pusan, Kyungnam area. 3) The predominant symptoms were general weakness (90.0%), abdominal pain (53.3%), jaundice (46.7%) in intrahepatic cholangiocarcinoma, and in extrahepatic cholangiocarcinoma, jaundice was the most frequent symptom (75.5%). 4) Of the 11 patients with distant metastases in in trahepatic cholangiocarcinoma, the most common site of metastases was abdominal lymph nodes (91 .O%) followed by liver (36.4%), peritoneum (27.3%) and kindey (18.2%). 5) Serum CEA level was more than 10ng/㎖ in 66.7% of intrahepatic cholangiocarcinoma and 26.5% of extrahepatic cholangiocarcinoma which suggested that serum CEA level may be more useful in the diagnosis of intrahepatic cholangiocarcinoma than extrahepatic cholangiocarcinoma. Serum CA 19-9 level was more than 37 U/㎖ in 80.0% of intrahepatic cholangiocarcinoma and 67.3% of extrahepatic cholangiocarcinoma. 6 ) Of the 11 patients with distant metastases in intrahepatic cholangiocarcinoma. 9 patients (81.8%) had serum CEA levels of more than 60ng/㎖, and 5 of 19 patients (26.3%) with localized tumor showed CEA levels of more than 60 ng/㎖, the difference between these two groups was statistically significant (p< 0.05).

Comparison of Clinical Characteristics between Occupational and Sporadic Young-Onset Cholangiocarcinoma

Kaneko, Rena,Kubo, Shoji,Sato, Yuzuru Asian Pacific Journal of Cancer Prevention 2015 Asian Pacific journal of cancer prevention Vol.16 No.16

Background: Since seventeen employees of an offset printing company in Osaka, Japan developed cholangiocarcinoma it has become recognized as an occupational cancer. This study investigated the differences of clinical features between occupational cholangiocarcinoma and sporadic young-onset cholangiocarcinoma. Materials and Methods: Thirty-four young adults (<50 years old) with sporadic cholangiocarcinoma were extracted from the Rosai Hospital Group database (sporadic group) and their clinical features were compared with those of 17 patients with occupational cholangiocarcinoma (occupational group). Results: The 34 patients in the sporadic group were treated for cholangiocarcinoma at 16 different Rosai hospitals. There were significant differences of age (p<0.01), gender (p<0.01), abnormal laboratory tests (p<0.01), and tumor location (p<0.01) between the two groups. The percentage of patients with abnormal laboratory tests was significantly higher in the occupational group than in the sporadic group (p<0.001). Regional dilation of bile ducts, which is a characteristic of occupational cholangiocarcinoma, was not observed in the sporadic group. Conclusions: No cluster of cholangiocarcinoma cases was identified in the Rosai Hospital database. There were differences of clinical features between occupational and sporadic cholangiocarcinoma, which might be helpful for diagnosing occupational cholangiocarcinoma in the future.

Natural History and Prognostic Factors of Advanced Cholangiocarcinoma without Surgery, Chemotherapy, or Radiotherapy: A Large-Scale Observational Study

( Jong Ha Park ),( Myung Hwan Kim ),( Kyu Pyo Kim ),( Do Hyun Park ),( Sung Hoon Moon ),( Tae Jun Song ),( Jun Bum Eum ),( Sang Soo Lee ),( Dong Wan Seo ),( Sung Koo Lee ) 대한소화기기능성질환·운동학회 2009 Gut and Liver Vol.3 No.4

Background/Aims: We aimed to evaluate survival time and prognostic factors in patients with advanced unresectable cholangiocarcinoma who have not received surgery, chemotherapy, or radiotherapy. Methods: A total of 1,377 patients, who were diagnosed with primary cholangiocarcinoma between 1996 and 2002, were reviewed retrospectively according to the following inclusion criteria: histologically proven primary adenocarcinoma arising from the bile-duct epithelium, advanced unresectable stages, no severe comorbidity that can affect survival time, and no history of surgery, chemotherapy, or radiotherapy. Results: Of the 1,377 cases reviewed, 330 patients complied with the inclusion criteria and were thus eligible to participate in this study; 203 had intrahepatic cholangiocarcinoma and 127 had hilar cholangiocarcinoma. The overall survival time of the entire cohort (n=330) was median 3.9 months (range; 0.2 to 67.1). The survival time was significantly shorter in the intrahepatic cholangiocarcinoma group (3.0±5.3 months) than in the hilar cholangiocarcinoma group (5.9±10.1 months; Kaplan-Meier survival analysis). Multivariate analysis revealed that distant metastasis was a poor prognostic factor for intrahepatic cholangiocarcinoma (p< 0.001), baseline serum albumin >3.0 g/dL was a favorable prognostic factor (p=0.02), and baseline serum carcinoembryonic antigen level >30 ng/mL was a poor prognostic factor for hilar cholangiocarcinoma (p=0.01). Conclusions: The median survival of advanced unresectable cholangiocarcinoma is dismal. (Gut and Liver 2009;3:298-305)

Comparison of the clinical results of surgical resection for extrahepatic cholangiocarcinomas: Hilar cholangiocarcinoma and mid-to-distal cholangiocarcinoma

Pyung Jung,Eung-Ho Cho,Sang-Bum Kim,Ryoung-Go Kim 한국간담췌외과학회 2019 Annals of hepato-biliary-pancreatic surgery Vol.23 No.4

Backgrounds/Aims: Hilar cholangiocarcinomas (HLC) are known to have worse prognoses than mid-to-distal cholangiocarcinomas (CBDC). We analyzed the clinical results of surgical resections for extrahepatic cholangiocarcinomas to validate the differences in the prognoses of HLC and CBDC. Methods: Two hundred and eighty-one patients underwent curative surgical resections for extrahepatic cholangiocarcinomas at the Department of Surgery in the Korea Cancer Center Hospital. Among them, we analyzed the T2 and T3 patients and compared the clinical results between those with HLC (n=74) and those with CBDC (n=65). Results: The rate of R1 resections was significantly higher in the HLC patients compared to the CBDC patients (31.1% vs 12.3%, p=0.006). The overall survival rate of the T2/T3 patients was lower in the HLC group than in the CBDC group (24.5% vs 51.7, p=0.039). The recurrence-free survival rate was 23.3% in the HCL patients and 50.9% in the CBDC patients (p=0.06). In the subgroup analysis, the survival rates were not different in patients who had lymph node metastases or in patients who underwent R1 resections between the HLC and CBDC patients. Poor independent prognostic factors for the overall and recurrence-free survival rates in the T2/T3 extrahepatic cholangiocarcinoma patients were the presence of lymph node metastases and the hilar locations of tumor. Conclusions: HLC patients had poorer prognoses than CBDC patients. However, in patients with lymph node metastases, the prognosis was poor and was not different between the HLC and CBDC patients. Other adjuvant treatment methods are needed for extrahepatic cholangiocarcinoma patients with lymph node metastases to improve their prognoses.

Descriptive Epidemiology of Cholangiocarcinoma and Clonorchiasis in Korea

Shin, Hai-Rim,Oh, Jin-Kyoung,Lim, Min Kyung,Shin, Aesun,Kong, Hyun-Joo,Jung, Kyu-Won,Won, Young-Joo,Park, Sohee,Park, Sang-Jae,Hong, Sung-Tae The Korean Academy of Medical Sciences 2010 JOURNAL OF KOREAN MEDICAL SCIENCE Vol.25 No.7

<P>In 2009, infection with the liver fluke <I>Clonorchis sinensis</I> (<I>C. sinensis</I>) was classified as 'carcinogenic to humans' (Group 1) based on its involvement in the etiology of cholangiocarcinoma by the International Agency for Research on Cancer. However, little is known about the descriptive epidemiology of cholangiocarcinoma in Korea. We examined incidence trends of intrahepatic and extrahepatic cholangiocarcinomas, using data from the Korea National Cancer Incidence database for 1999-2005. The prevalence of <I>C. sinensis</I> infection was estimated from a recent population-based survey in rural endemic areas. Cholangiocarcinoma incidence rates are currently rising, even while primary liver cancer incidence rates are decreasing. Annual percent changes in cholangiocarcinoma incidence rates were 8% for males and 11% in females. Known areas of <I>C. sinensis</I> endemicity showed high incidence rates of cholangiocarcinoma. The positivity of <I>C. sinensis</I> eggs in stool samples from endemic areas was more than 25% of adults tested during 2005-2008. From a meta-analysis, the summary odds ratio for cholangiocarcinoma due to <I>C. sinensis</I> infection was 4.7 (95% confidence interval: 2.2-9.8). Approximately 10% of cholangiocarcinomas in Korea were caused by chronic <I>C. sinensis</I> infections. More specific policies, including health education and an extensive effort for early detection in endemic areas, are needed.</P>

Plasma Lipidomics as a Tool for Diagnosis of Extrahepatic Cholangiocarcinoma in Biliary Strictures: a Pilot Study

Prachayakul, Varayu,Thearavathanasingha, Phataraphong,Thuwajit, Chanitra,Roytrakul, Sittiruk,Jaresitthikunchai, Janthima,Thuwajit, Peti Asian Pacific Journal of Cancer Prevention 2016 Asian Pacific journal of cancer prevention Vol.17 No.8

Biliary obstruction is a common clinical manifestation of various conditions, including extrahepatic cholangiocarcinoma. However, a screening test for diagnosis of extrahepatic cholangiocarcinoma in patients with biliary obstruction is not yet available. According to the rationale that the biliary system plays a major role in lipid metabolism, biliary obstruction may interfere with lipid profiles in the body. Therefore, plasma lipidomics may help indicate the presence or status of disease in biliary obstruction suspected extrahepatic cholangiocarcinoma. This study aimed to use plasma lipidomics for diagnosis of extrahepatic cholangiocarcinoma in patients with biliary obstruction. Plasma from healthy volunteers, patients with benign biliary obstruction extrahepatic cholangiocarcinoma, and other related cancers were used in this study. Plasma lipids were extracted and lipidomic analysis was performed using matrix-assisted laser desorption ionization time-of-flight mass spectrometry. Lipid profiles from extrahepatic cholangiocarcinoma patients showed significant differences from both normal and benign biliary obstruction conditions, with no distinction between the latter two. Relative intensity of the selected lipid mass was able to successfully differentiate all extrahepatic cholangiocarcinoma samples from patient samples taken from healthy volunteers, patients with benign biliary obstruction, and patients with other related cancers. In conclusion, lipidomics is a non-invasive method with high sensitivity and specificity for identification of extrahepatic cholangiocarcinoma in patients with biliary obstruction.

Descriptive Epidemiology of Cholangiocarcinoma and Clonorchiasis in Korea

신해림,오진경,임민경,신애선,공현주,정규원,원영주,박소희,박상재,홍성태 대한의학회 2010 Journal of Korean medical science Vol.25 No.7

In 2009, infection with the liver fluke Clonorchis sinensis (C. sinensis) was classified as “carcinogenic to humans” (Group 1) based on its involvement in the etiology of cholangiocarcinoma by the International Agency for Research on Cancer. However, little is known about the descriptive epidemiology of cholangiocarcinoma in Korea. We examined incidence trends of intrahepatic and extrahepatic cholangiocarcinomas, using data from the Korea National Cancer Incidence database for 1999-2005. The prevalence of C. sinensis infection was estimated from a recent population-based survey in rural endemic areas. Cholangiocarcinoma incidence rates are currently rising, even while primary liver cancer incidence rates are decreasing. Annual percent changes in cholangiocarcinoma incidence rates were 8% for males and 11% in females. Known areas of C. sinensis endemicity showed high incidence rates of cholangiocarcinoma. The positivity of C. sinensis eggs in stool samples from endemic areas was more than 25% of adults tested during 2005-2008. From a meta-analysis, the summary odds ratio for cholangiocarcinoma due to C. sinensis infection was 4.7 (95% confidence interval: 2.2-9.8). Approximately 10% of cholangiocarcinomas in Korea were caused by chronic C. sinensis infections. More specific policies, including health education and an extensive effort for early detection in endemic areas, are needed.

Anticancer activity of streptochlorin, a novel antineoplastic agent, in cholangiocarcinoma

Kwak, Tae Won,Shin, Hee Jae,Jeong, Young-Il,Han, Myoung-Eun,Oh, Sae-Ock,Kim, Hyun-Jung,Kim, Do Hyung,Kang, Dae Hwan Dove Medical Press 2015 Drug design, development and therapy Vol.9 No.-

<P><B>Background</B></P><P>The aim of this study is to investigate the anticancer activity of streptochlorin, a novel antineoplastic agent, in cholangiocarcinoma.</P><P><B>Methods</B></P><P>The anticancer activity of streptochlorin was evaluated in vitro in various cholangiocarcinoma cell lines for apoptosis, proliferation, invasiveness, and expression of various protein levels. A liver metastasis model was prepared by splenic injection of HuCC-T1 cholangiocarcinoma cells using a BALB/c nude mouse model to study the systemic antimetastatic efficacy of streptochlorin 5 mg/kg at 8 weeks. The antitumor efficacy of subcutaneously injected streptochlorin was also assessed using a solid tumor xenograft model of SNU478 cells for 22 days in the BALB/c nude mouse.</P><P><B>Results</B></P><P>Streptochlorin inhibited growth and secretion of vascular endothelial growth factor by cholangiocarcinoma cells in a dose-dependent manner and induced apoptosis in vitro. In addition, streptochlorin effectively inhibited invasion and migration of cholangiocarcinoma cells. Secretion of vascular endothelial growth factor and activity of matrix metalloproteinase-9 in cholangiocarcinoma cells were also suppressed by treatment with streptochlorin. Streptochlorin effectively regulated metastasis of HuCC-T1 cells in a mouse model of liver metastasis. In a tumor xenograft study using SNU478 cells, streptochlorin significantly inhibited tumor growth without changes in body weight when compared with the control.</P><P><B>Conclusion</B></P><P>These results reveal that streptochlorin is a promising chemotherapeutic agent to the treatment of cholangiocarcinoma.</P>

간내 담관암: 최신 개념 및 내과적 치료

김홍자 ( Hong Ja Kim ) 대한췌장담도학회 2021 대한췌담도학회지 Vol.26 No.1

담관암은 병변의 해부학적 위치에 따라 간내 담관암과 간외 담관암으로 분류하며 간외 담관암은 다시 간문주변부 담관암과 원위부 담관암으로 분류한다. 간외 담관암의 발병률은 수십 년동안 정체되어 있으나 간내 담관암은 전 세계적으로 꾸준히 증가하고 있으며 예후가 극히 나빠 많은 관심이 필요하다. 간내 담관암은 고식적인 해부학적 위치에 따른 분류뿐 아니라 성장패턴, 조직 학적 소견, 종양 유래 세포에 기반한 다양한 분류 시스템이 제안되어 있으나 아직 합의가 이루어지지 않고 있다. 완전한 종양 절제술이 유일한 치료법이다. 그러나 수술 후 5년동안의 전체 생존율은 15-40%이며 수술 후 재발하는 환자는 2/3에 달한다. 따라서 수술 전 올바른 병기 결정 및 다학제적 접근을 통한 적절한 치료 방법의 선택은 환자의 예후를 결정하는 중요한 과정이다. 다양한 전신 요법은 수술이 불가능한 국소 진행성 담도암 또는 전이성 담도암에 사용될 수 있으나 전통적인 항암 화학 요법제의 효과는 다소 비관적이다. 최근 분자 생물학적 특성을 이용한 치료가 시도되고 있으나 그 효과는 아직 입증되지 않아 조기 진단을 통해 절제 가능한 사례의 수를 늘리는 방법을 찾는 것이 주요 과제 중 하나로 고려되고 있다. 그러나 향후 담관암의 유전자 발현 프로파일 및 돌연변이에 대한 고도의 연구 결과로 새로운 치료 표적 및 치료제가 선정되어 예후가 개선되기를 기대한다. Cholangiocarcinoma (bile duct cancer) is classified into intrahepatic and extrahepatic cholangiocarcinoma (perihilar and distal cholangiocarcinoma) according to the anatomical location of the lesion. The incidence of extrahepatic cholangiocarcinoma has been relatively stagnant in recent decades, but intrahepatic cholangiocarcinoma is steadily increasing worldwide, requiring attention. Various classification systems based on gross growth patterns, histological findings, and tumor-derived cells, as well as classification based on existing anatomical location, have been proposed, however, the consensus has not been established yet. Intrahepatic cholangiocarcinoma is a carcinoma with an extremely poor prognosis. Complete tumor resection is the only curative treatment. The overall survival rate for 5 years after surgery is 15% to 40%, but recurrence after surgery is observed in 2/3 patients. Therefore, determining the right stage before surgery and selecting an appropriate treatment method through a multidisciplinary approach is a very important process in determining proper treatment. Systemic therapy may be used for locally advanced biliary tract cancer or metastatic biliary tract cancer where surgery is not possible. However, the effectiveness of traditional anticancer chemotherapeutic agents is rather pessimistic, therefore treatments using molecular biological properties have recently been attempted. Finding a way to increase the number of resectable cases through early diagnosis is one of the main challenges. In addition, it is also hoped that the selection of new therapeutic targets and therapeutics will be possible as a result of advanced research on gene expression profiles and mutations in cholangiocarcinoma. Korean J Pancreas Biliary Tract 2021;26(1):33-42

간 및 경부 림프절 생검으로 진단된 혼합 간세포-담관상피암종

강혜원,박재정,문일환,김서우,김현경,오현정,김고흔,최윤정,허현미,노영욱,김태헌,유 권,배지윤,송동은 이화여자대학교 의과대학 2009 EMJ (Ewha medical journal) Vol.32 No.2

Mixed hepatocellular-cholangiocarcinoma accounts for about 1% of all hepatocellular carcinoma. In many cases, mixed hepatocellular-cholangiocarcinoma has been misdiagnosed as hepatocellular carcinoma or cholangiocarcinoma because of the indistinctive clinical course and radiologic findings. The clinical course and the pathologic characters are not known well, but it resembles the characteristics of hepatocellularcarcinoma rather than cholangiocarcinoma. So mixed hepatocellular-cholangiocarcinoma was classified as a kind of hepatocellular carcinoma. But the growth and dissemination rate is faster than that of hepatocellular carcinoma and the prognosis more poor. So the exact diagnosis is important. Authors experienced a patient who has the mixed hepatocellular-cholangiocarcinoma diagnosed by liver and neck node biopsy in patient who complain-ed abdominal discomfort and palpable mass, so we report the case.