Dilemma of the differential diagnosis of hilar cholangiocarcinoma and benign diseases: a single-center retrospective study
Dilemma of the differential diagnosis of hilar cholangiocarcinoma and benign diseases: a single-center retrospective study
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肝门部胆管癌与良性疾病鉴别诊断的困境：单中心回顾性研究
DOI：
10.1093/carcin/bgaa125
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发表时间：
2021-02-05
期刊：
影响因子：
4.7
通讯作者：
Kong, Jing
中科院分区：
文献类型：
--
作者：
Pang, Liwei;Hu, Shangzhi;Kong, Jing
肝门部胆管细胞癌(HCCA)缺乏特殊的临床表现，很难与良性疾病相鉴别。这种区别由于复杂的肺门解剖结构而变得更加复杂。我们进行了这项研究，以评估这些疾病的鉴别诊断。2011年1月至2018年10月，65名疑似HCCA患者接受了切除手术。盛京医院机构评审委员会同意了这项研究，所有参与者在参与研究之前签署了知情同意文件。术后病理分析将所有患者分为恶性组(54例)和良性组(11例)。恶性组的中位年龄、血清CA19-9、CEA、ALT、BILT和BILD水平均显著高于良性组(P<；0.05)。相反，两组在性别分布、临床表现、血清AST和ALKP水平以及影像表现方面没有显著差异。在受试者工作特征曲线分析中，我们确定了CA19-9鉴别诊断的临界点为233.15 U/ml，癌胚抗原鉴别诊断的临界点为2.98 ng/ml。HCCA与肝门部良性病变的鉴别诊断仍很困难。然而，我们发现，HCCA患者的发病年龄较大，血清CA199、CEA、BILT、ALT和BILD水平较高。此外，血清CA19-9水平<233.15 U/ml和癌胚抗原水平<2.98 ng/ml的患者更容易发生恶性疾病。
Hilar cholangiocarcinoma (HCCA), which lacks specific clinical manifestations, remains very difficult to distinguish from benign disease. This distinction is further complicated by the complex hilar anatomy. We conducted the present study to evaluate the differential diagnosis of these conditions. Sixty-five patients underwent resection surgery for suspected HCCA between January 2011 and October 2018. Institutional Review Board of Shengjing hospital agreed this study and all participants sign an informed consent document prior to participation in a research study. Following a postoperative pathology analysis, all patients were divided into two groups: malignant group (54 patients with HCCA) and benign group (11 cases with benign lesions). Compared with the benign group, the malignant group had a significantly higher median age and serum CA19-9, CEA, ALT, BILT and BILD levels (P < 0.05). In contrast, the groups did not differ significantly in terms of the sex distribution, clinical manifestations, serum levels of AST and ALKP, and imaging findings. In a receiver operating characteristic curve analysis, we identified a CA19-9 cutoff point of 233.15 U/ml for the differential diagnosis and CEA cutoff point of 2.98 ng/ml for the differential diagnosis. The differential diagnosis of HCCA and benign hilar lesions remains difficult. However, we found that patients with HCCA tended to have an older age at onset and higher serum levels of CA199, CEA, BILT, ALT and BILD. Furthermore, patients with a serum CA19-9 level >233.15 U/ml and CEA level >2.98 ng/ml are more likely to have malignant disease.