Epidemiology of hilar cholangiocarcinoma in Egypt: single center study

Cholangiocarcinoma is the second most frequent malignant tumor of the liver after hepatocellular carcinoma. The incidence rates of hilar cholangiocarcinoma (CC) vary greatly among different areas of the world, this variation is related to distribution of risk factors. The aim of this work is to study epidemiology and possible risk factors in the North East delta of Egypt.

This study included 440 patients with hilar cholangiocarcinoma who were admitted to the Gastrointestinal Surgical Center, Mansoura University between January 1995 and October 2004. After complete evaluation by thorough history, clinical examination, biochemical assessment including liver function tests, kidney function tests, blood picture and serology of viral markers, tumor markers and radiological investigation.

The mean age was 54.49 +/- 12.8 (range 23 to 82 year). Male to female ratio was 1.7:1, with increasing annual incidence from 22 patients at 1995 up to 68 patients in 2003 and 60 patients in the first 10 months of 2004. Hilar CC is common in patients coming from rural areas especially in Dakahlia government area (41%). All patients presented with jaundice, while weight loss was presented in 41%, and right upper abdominal pain in 37% of patients. Positive history of schistosomiasis infection was encountered in 66.5% while typhoid infection was in 52% of patients with high prevalence of both in rural versus urban (89% vs. 13%, p < 0.001 & 66% vs. 25%, p < 0.001). Laboratory assessment revealed 238 (54%) patients HCV positive while HBs antigen positive in 10 (2%) with high significant increase of HCV in rural versus urban (70% vs. 16%, p < 0.001). Gallstones was significantly higher in rural versus urban (28% vs. 40%, p = 0.016). The laboratory data showed highly significant increase in serum alkaline phosphatase, CA19.9 (26.9 +/- 1 4.4mg/dL, 56.3 +/- 30.6 KAU, 517.8 +/- 279.2 u/mL respectively).

We conclude that, the number of newly diagnosed cases increases annually, it is common in males especially in farmers and rural residents. Liver cirrhosis, HCV, bilharziasis, chronic typhoid infection and gallstones can be possible risk factors for hilar cholangiocarcinoma in Egypt.