Yutaka Suzuki1, Toshiyuki Mori2, Masaaki Yokoyama2, Sangchul Kim2, Hirokazu Momose2, Ryota Matsuki2, Masaharu Kogure2, Nobutsugu Abe2, Hiroyuki Isayama3, Takahiro Nakazawa4, Kenji Notohara5, Atsushi Tanaka6, Toshio Tsuyuguchi7, Susumu Tazuma8, Hajime Takikawa6, Masanori Sugiyama2. 1. Department of Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan. ysuzuki@ks.kyorin-u.ac.jp. 2. Department of Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan. 3. Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo, Japan. 4. Department of Gastroenterology, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan. 5. Department of Anatomic Pathology, Kurashiki Central Hospital, Kurashiki, Japan. 6. Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan. 7. Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan. 8. Department of General Medicine, Graduate School of Medical Science, Hiroshima University, Hiroshima, Japan.
Abstract
BACKGROUND: Hepatolithiasis frequently results in severe complications. We conducted a cohort study to identify prognostic factors and to establish a hepatolithiasis severity classification system. METHODS: The study cohort comprised 396 patients who were identified through a 1998 nationwide survey and followed up for 18 years or until death. Cox regression analysis was used to identify prognostic factors. RESULTS: Median survival time of the patients was 308 (range 0-462) months. Of the 396 patients enrolled in the study, 118 (29.8%) died, most frequently from intrahepatic cholangiocarcinoma (25 patients, 21.2%). Age of ≥ 65 years at the time of initial diagnosis [hazard ratio (HR) 3.410], jaundice for ≥ 1 week during follow-up (HR 2.442), intrahepatic cholangiocarcinoma (HR 3.674), and liver cirrhosis (HR 5.061) were shown to be significant risk factors for death from any therapeutic course. The data led to a 3-grade disease severity classification system that incorporates intrahepatic cholangiocarcinoma and liver cirrhosis as major factors and age of ≥ 65 years and jaundice for ≥ 1 week during follow-up as minor factors. Survival rates differed significantly between grades. CONCLUSIONS: The proposed hepatolithiasis severity classification system can be used to assess prognosis and thereby improve patient outcomes.
BACKGROUND: Hepatolithiasis frequently results in severe complications. We conducted a cohort study to identify prognostic factors and to establish a hepatolithiasis severity classification system. METHODS: The study cohort comprised 396 patients who were identified through a 1998 nationwide survey and followed up for 18 years or until death. Cox regression analysis was used to identify prognostic factors. RESULTS: Median survival time of the patients was 308 (range 0-462) months. Of the 396 patients enrolled in the study, 118 (29.8%) died, most frequently from intrahepatic cholangiocarcinoma (25 patients, 21.2%). Age of ≥ 65 years at the time of initial diagnosis [hazard ratio (HR) 3.410], jaundice for ≥ 1 week during follow-up (HR 2.442), intrahepatic cholangiocarcinoma (HR 3.674), and liver cirrhosis (HR 5.061) were shown to be significant risk factors for death from any therapeutic course. The data led to a 3-grade disease severity classification system that incorporates intrahepatic cholangiocarcinoma and liver cirrhosis as major factors and age of ≥ 65 years and jaundice for ≥ 1 week during follow-up as minor factors. Survival rates differed significantly between grades. CONCLUSIONS: The proposed hepatolithiasis severity classification system can be used to assess prognosis and thereby improve patient outcomes.