A high prevalence of metabolic disorders, including overweight/obesity and diabetes, has been observed among patients with cholangiocarcinoma (CCA), highlighting the need to further assess patients with the disease who present with suspected laboratory hepatic alterations.

A retrospective cohort of patients who were diagnosed with CCA between October 2013 and January 2021 and treated at Instituto do Cancer do Estado de São Paulo in Brazil were enrolled in a recent study. All participants had a confirmed histologic diagnosis of CCA obtained with the use of percutaneous biopsy, fine-needle aspiration, or surgical resection. Results of the analysis were published in the journal Cancers (Basel).

CCA denotes a heterogeneous entity because of the varying anatomical site of origin—that is, intrahepatic, perihilar, and distal—as well as differences in molecular features that are actively being explored. The incidence of CCA is on the rise globally.

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Recognizing that a lack of relevant data on the subject exists, the investigators sought to describe the prevalence of metabolic disorders among patients with CCA, and report on the clinical features and outcomes. A total of 122 participants were enrolled in the study and divided into 2 groups: (1) those with a past history of diabetes and/or overweight/obesity, who made up the metabolic disorder group (n=52), and (2) those without any of these features, who made up the nonmetabolic disorder group (n=70).

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Overall, 29.5% (36 of 122) of the participants had overweight/obesity, 19.7% (24 of 122) of them had diabetes, and 6.6% (8 of 122) of them had both. A total of 23.8% (29 of 122) of the patients had resectable disease and underwent upfront surgery. In all, 85.2% (104 of 122) of the participants received chemotherapy for the treatment of advanced/recurrent disease.

Overall survival of the study cohort was 14.3 months (95% CI, 10.1 to 17.3 months). Eastern Cooperative Oncology Group performance status of 0, resectable disease, and absence of vascular invasion were all independently associated with improved prognosis among participants (P <.0001, P =.018, and P =.048, respectively).

In the metabolic disorder group, the median survival was 15.5 months (95% CI, 10.9 to 33.9 months), compared with 11.5 months (95% CI, 8.4 to 16.5 months) in the nonmetabolic disorder group (hazard ratio [HR], 1.10; 95% CI, 0.62 to 1.94). Participants with resectable disease in the metabolic arm had longer survival than did those in the non-metabolic arm (43.4 months vs 21.8 months, respectively; HR, 0.12; 95% CI, 0.03 to 0.59).

The investigators concluded that the presence of underlying metabolic comorbidities may be linked to prognosis in patients with CCA. “There is a need to explore the mechanism that drives CCA carcinogenesis in a metabolic background.”


Da Fonseca LG, Hashizume PH, de Oliveira IS, et al. Association between metabolic disorders and cholangiocarcinoma: impact of a postulated risk factor with rising incidence. Cancers (Basel). 2022;14(14):3483. doi:10.3390/cancers14143483