Seyed Alireza Taghavi
Negar Asgharpour
Najibullah Baerade

Introduction: Cholangiocarcinoma (CCA) is the most common malignancy in patients with primary sclerosing cholangitis (PSC). The aim of this study was to delineate predictive factors for cholangiocarcinoma in patients with Primary Sclerosing Cholangitis. Methods: in this study we gathered the information of ۴۵۰ liver transplant patient with definite diagnose of PSC with/without CCA from Abu Ali Sina Hospital (the largest center of hepatobiliary surgery in the south of Iran) between ۲۰۱۶-۲۰۲۱. The logistic regression method was used to identify the factors associated with CCA. Results: We reviewed ۴۵۰ transplanted cases of PSC. Amongst these, cholangiocarcinoma was ۱۸.۲% (n =۸۲). Significant risk factors in univariate analysis included Carbohydrate antigen ۱۹-۹ (CA ۱۹.۹), Hilar lymph node in CT Scan & MRCP, Stricture in CT scan & MRCP, mass in CT scan & MRCP, and age of PSC diagnosis, taking medication (azaram,sulfasalazine,mesalazine,ursoflor). In our study azaram medicine proved to have a remarkable protective effect among PSC patients against cholangiocarcinoma. Multiple logistic regression analysis showed that factors of CA ۱۹-۹(OR: ۴.۸۸۸ ; ۹۵% CI:۱.۸۱۶-۱۳.۱۵۷), Hilar lymph node in CT Scan & MRCP (OR: ۲.۶۵۲ ; ۹۵% CI:۱.۴۰۶-۵.۰۰۴),Stricture in CT scan (OR: ۵.۱۵۳ ; ۹۵% CI:۱.۶۳۴-۱۶.۲۴۴) and Mass in CT scan & MRCP (OR: ۲.۵۶۵ ; ۹۵% CI:۱.۳۲۸-۴.۹۵۳) are important predictors of cholangiocarcinoma. Conclusion: Several risk factors for CCA have been identified. Due to the late diagnosis of cholangiocarcinoma by regular examining of PSC patients and considering clinical trials and combining CT scan and MRCP reports, people at higher risk of this cancer can be identified.

Primary sclerosing cholangitis (PSC); Etiology; Pathogenesis; Immunology; Surveillance; Diagnosis; risk factors; Therapy; Transplantation; Malignancy; Cholangiocarcinoma (CCA), endoscopic retrograde cholangiopancreatography (ERCP), MR cholangiopancreatography (MRCP); predictive factors