Removal of intrahepatic bile duct stone could reduce the risk of cholangiocarcinoma: A single-center retrospective study in South Korea

A combined radiomics and clinical model for preoperative differentiation of intrahepatic cholangiocarcinoma and intrahepatic bile duct stones with cholangitis: a machine learning approach

Background

This study aimed to develop and validate a predictive model integrating radiomics features and clinical variables to differentiate intrahepatic bile duct stones with cholangitis (IBDS-IL) from intrahepatic cholangiocarcinoma (ICC) preoperatively, as accurate distinction is crucial for determining appropriate treatment strategies.

Methods

A total of 169 patients (97 IBDS-IL and 72 ICC) who underwent surgical resection were retrospectively analyzed. Radiomics features were extracted from ultrasound images, and clinical variables with significant differences between groups were identified. Feature selection was performed using LASSO regression and recursive feature elimination (RFE). The radiomics model, clinical model, and combined model were constructed and evaluated using the area under the curve (AUC), calibration curves, decision curve analysis (DCA), and SHAP analysis.

Results

The radiomics model achieved an AUC of 0.962, and the clinical model achieved an AUC of 0.861. The combined model, integrating the Radiomics Score with clinical variables, demonstrated the highest predictive performance with an AUC of 0.988, significantly outperforming the clinical model (p < 0.05). Calibration curves showed excellent agreement between predicted and observed outcomes, and the Hosmer-Lemeshow test confirmed a good model fit (p = 0.998). DCA revealed that the combined model provided the greatest clinical benefit across a wide range of threshold probabilities. SHAP analysis identified the Radiomics Score as the most significant contributor, complemented by abdominal pain and liver atrophy.

Conclusion

The combined model integrating radiomics features and clinical data offers a powerful and reliable tool for preoperative differentiation of IBDS-IL and ICC. Its superior performance and clinical interpretability highlight its potential for improving diagnostic accuracy and guiding clinical decision-making. Further validation in larger, multicenter datasets is warranted to confirm its generalizability.

FTO-mediated regulation of Kupffer cell polarization and interleukin-6 secretion promotes biliary epithelial cell proliferation in intrahepatic bile duct stones

Objective

Intrahepatic cholangiolithiasis (Intrahepatic bile duct stones, IBDSs) is a common hepatobiliary disease characterized by bile duct obstruction and inflammation, often leading to severe complications such as cholangitis, cirrhosis, and cholangiocarcinoma. This study investigates the role of fat mass and obesity-associated (FTO) protein, an RNA demethylase, in regulating Kupffer cell (KC) polarization, interleukin (IL)-6 secretion, and subsequent human intrahepatic biliary epithelial cell (HiBEC) proliferation in IBDS.

Material and Methods

Liver tissues from patients with IBDS were analyzed for FTO expression, KC M2 polarization, and IL-6 levels. In vitro experiments with FTO silencing in KCs were conducted to examine the effects on M2 polarization, IL-6 production, and HiBEC proliferation. Mechanistic analysis focused on the c-Jun N-terminal kinase (JNK)/p38 and phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT) pathways.

Results

The patients with IBDS showed significantly higher KC M2 polarization, elevated FTO expression, and increased IL-6 levels relative to the controls. Without FTO silencing, IL-6 secretion and HiBEC proliferation remained at high baseline levels. However, FTO silencing reduced M2 polarization, IL-6 secretion, and HiBEC proliferation through the JNK/p38 pathway. Activating the PI3K/AKT pathway partially reversed these inhibitory effects.

Conclusion

FTO plays a critical role in IBDS by promoting the M2 polarization of KCs, which leads to increased IL-6 secretion and induced pathological HiBEC proliferation. Targeting FTO may represent a novel therapeutic strategy for managing IBDS and preventing disease progression.

Removal of intrahepatic bile duct stone could reduce the risk of cholangiocarcinoma

Hepatolithiasis (HL) poses a significant risk for cholangiocarcinoma (CCA) development, with reported incidences ranging from 5%-13%. Risk factors include older age, smoking, hepatitis B infection, and prolonged HL duration. Chronic inflammation and mechanical stress on the biliary epithelium contribute to CCA pathogenesis. Hepatectomy reduces CCA risk by removing stones and atrophic liver segments. However, residual stones and incomplete removal increase CCA risk. Kim et al identified carbohydrate antigen 19-9, carcinoembryonic antigen, and stone laterality as CCA risk factors, reaffirming the importance of complete stone removal. Nonetheless, challenges remain in preventing CCA recurrence post-surgery. Longer-term studies are needed to elucidate CCA risk factors further.