Does Non-Alcoholic Fatty Liver Disease Increase the Risk of Cholangiocarcinoma? A Single Center Retrospective Review: 2946

INTRODUCTION: Cholangiocarcinoma is a highly aggressive cancer of the bile duct epithelium, usually diagnosed at an advanced stage. Limited research has shown evolving risk factors and pathogenesis of cholangiocarcinoma. Studies have revealed a link between Non-Alcoholic Fatty Liver Disease (NAFLD) and cholangiocarcinoma, mainly intrahepatic cholangiocarcinoma. The major risk factors for NAFLD- include obesity, impaired fasting glucose, dyslipidemia, and metabolic syndrome. In this study, we aim to determine a possible association between NAFLD and cholangiocarcinoma. METHODS: The electronic medical records were retrospectively reviewed for adults with NAFLD, Intrahepatic cholangiocarcinoma (ICC) and Extrahepatic cholangiocarcinoma (ECC) by ICD code, imaging, or pathological report. Exclusion criteria were; alcoholic liver disease, primary sclerosing cholangitis, hepatitis B & C, HIV infection, and inflammatory bowel disease between March 2012-2019. Analysis was conducted on possible risk factors such as NAFLD, metabolic syndrome and subsequent risks; diabetes mellitus, BMI, dyslipidemia, hypertension (HTN), and coronary artery disease. RESULTS: A total of 59 patients with diagnosis of cholangiocarcinoma was collected and classified into ICC (N = 48) and ECC (N = 10) with mean age of 72 years. Gender distribution was 54% females and 46% males, in ICC and 40% females vs 60% males in ECC, respectifully. 18% of patients with ICC had NAFLD in comparison with 0% in the ECC class. Fisher exact test showed 37.5% of patients with ICC had metabolic syndrome vs 30% of patients with ECC, but this was statistically not significant. Each individual risk factor for metabolic syndrome was further analyzed and among these 81% of patients with ICC had HTN and was statistically significant vs 50% of ECC cases had HTN. CONCLUSION: Our cohort did not demonstrate an association between NAFLD and cholangiocarcinoma. Our sample size was low and ICC had more representation than ECC. Diagnoses of NAFLD was obtained mainly by imaging and pathology results rather than ICD codes, but underrepresented in our study in comparison to the general population, likely from undercoding. There was no association between gender, age, metabolic syndrome or its risk factors, except HTN, which was prevalent in the ICC group with statistical significance. This finding was not seen in prior studies. This could likely represent more prevalence of HTN overall in the cohort, however more research is helpful in determining this possible association.