Risk Factors of Incidental Cholangiocarcinoma in Primary Sclerosing Cholangitis: A Cross-Sectional Study with ROC Curve Analysis.

Authors

Fardad Ejtehadi, Saeid Hashemieh, Ali Reza Safarpour, Sara Shojaei-Zarghani, Salar Azadnik, Alireza Shamsaeefar, Nima Rahimikashkooli

Published in

Archives of Iranian medicine. Volume 29. Issue 1. Pages 29-34. Jan 01, 2026. Epub Jan 01, 2026.

Abstract

Cholangiocarcinoma (CCA) is the most common malignancy in patients with primary sclerosing cholangitis (PSC). It is typically associated with low survival rates due to late diagnosis. This study aimed to evaluate the predictors of incidental CCA in PSC patients.
In this cross-sectional study, we included 425 patients aged 18 years or older who underwent liver transplant with a confirmed diagnosis of PSC. Demographic data, pre-transplant clinical features, and para-clinical evidence were obtained from medical records. Pathology experts examined livers removed during transplantation, and CCA was diagnosed accordingly. Multivariable logistic regression and receiver operating characteristic (ROC) curve analyses were conducted to assess the risk factors for incidental CCA and the effectiveness of carbohydrate antigen 19-9 (CA 19‒9) in predicting CCA, respectively.
Of the 425 included patients, 29 had PSC-CCA and 396 patients had PSC alone. According to the multivariable logistic model, CA 19‒9 (odds ratio [OR]=1.001, 95% confidence interval [CI]: 1.000‒1.001, P-value=0.041) and weight loss (OR=4.712, 95% CI: 1.392 to 15.947, P-value=0.013) were significantly associated with CCA development. ROC curve analysis also revealed that CA 19‒9 could predict CCA (AUC=0.737; 95% CI: 0.689‒0.782) at an optimal cut-off point above 46 U/mL, with a good sensitivity (68%, bootstrapped 95% CI: 62‒74%) and specificity (72.32%, bootstrapped 95% CI: 68‒76%).
We found that CA 19‒9 and weight loss are independent predictors of incidental CCA in PSC patients, and a CA 19‒9 level above 46 U/mL has relatively good predictive power for incidental CCA.

PMID:
42604418
Bibliographic data and abstract were imported from PubMed on 16 Aug 2026.

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