Hepatobiliary carcinoma in primary sclerosing cholangitis: a case control study

Backround/Aims: Hepatobiliary carcinoma (HBC) has been considered to be a l ate complication of end-stage primary sclerosing cholangitis (PSC). The inc idence of HBC is approximately 20% in PSC patients evaluated for liver tran splantation. The diagnosis of HBC is difficult, at least at an early stage and the prognosis is poor even after liver transplantation. The aim of the study was to look for signs and risk factors for developing hepatobiliary c arcinoma in patients with PSC. Methods: Thirty-six consecutive patients with PSC and HBC (32 with bile duc t carcinoma, BDC, and four with hepatocellular carcinoma, HCC) were pair-ma tched to control patients referred for liver transplantation because of PSC but who did not have HBC. Gender and age at referral were used as matching factors. Clinical and biochemical data were registered. Results: PSC patients with BDC had a shorter median duration of PSC (1 year ) compared with the controls (7 years) and PSC patients with HCC (8 years). There were no statistically significant differences in the liver biochemis try between the patient groups. Varices were more common in patients with P SC and HCC (100%) than in controls (56%) or patients with PSC and HBC (12%) (P < 0.0005). Conclusions: The relatively short duration of PSC and the absence of varice s in patients with BDC suggest that BDC, unlike HCC, is not necessarily a l ate complication of end-stage PSC, as was previously assumed. 2001 European Association for the Study of the Liver. Published by Elsevier Science B.V. All rights reserved.