Risk factors for biliary tract carcinogenesis
Risk factors for biliary tract carcinogenesis
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DOI：
10.1023/a:1008313809752
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发表时间：
1999-01-01
影响因子：
50.5
通讯作者：
Chapman, RW
中科院分区：
文献类型：
--
作者：
Chapman, RW
胆管癌在世界范围内分布，约占所有原发性肝胆恶性肿瘤病例的10-15%。尽管在大多数情况下无法确定病因，但许多危险因素已被证明在胆管癌的发生过程中发挥着重要作用；这些因素中的大多数都与胆管上皮的长期炎症和慢性损伤有关。原发性硬化性胆管炎是一种罕见疾病，其特征是胆管系统狭窄、纤维化和炎症，与慢性炎症性肠病，特别是溃疡性结肠炎密切相关。它通常与胆管癌相关，10-20% 的原发性硬化性胆管炎患者会继续发展为胆管癌。胆道系统罕见的先天性纤维多囊性疾病与胆管癌的风险增加有关，特别是胆总管囊肿和卡罗利氏病。胆总管囊肿与胆管癌总发病率 10% 有关；累积风险为 1%，并在 15-20 年后趋于稳定。然而，10 岁以下儿童的风险较低，总体风险为 0.7%。相比之下，20 岁以上患者的总风险为 14%。 在远东，与胆管癌相关的其他形式的慢性炎症包括肝吸虫、华支睾吸虫和后吸虫感染。胆管癌也很少见与肝硬化相关，并且与丙型肝炎感染的关系微弱。
Cholangiocarcinoma has a worldwide distribution which accounts for about 10-15% of all cases of primary hepatobiliary malignancy. Although, in the majority of cases, no aetiological factor can be identified, a number of risk factors have been shown to be important in the development of cholangiocarcinoma; most of these factors share long standing inflammation and chronic injury of the biliary epithelium. Primary sclerosing cholangitis is an uncommon disease, characterized by stricturing, fibrosis and inflammation of the biliary tree which is closely associated with chronic inflammatory bowel disease, particularly ulcerative colitis. It is commonly associated with cholangiocarcinoma and between 10-20% of patients with primary sclerosing cholangitis will go on to develop a cholangiocarcinoma. The rare congenital fibropolycystic diseases of the biliary system are associated with increased risks of cholangiocarcinoma, particularly choledochal cysts and Caroli's disease. Choledochal cysts are associated with a 10% overall incidence of cholangiocarcinoma; there is a 1% cumulative risk which plateaus after 15-20 years. However, the risk is diminished in children who present under the age of 10 years where the over all risk is 0.7%. This compares with the 14% over all risk of patients presenting over the age of 20 years.In the Far East, other forms of chronic inflammation associated with cholangiocarcinoma include infestation with liver flukes, Clonorchis sinensis and Opisthorchis viverinni. Cholangiocarcinoma is also rarely seen in association with cirrhosis and has been weakly linked to hepatitis C infection.