Systematic Reviews
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 14, 2015; 21(10): 3066-3071
Published online Mar 14, 2015. doi: 10.3748/wjg.v21.i10.3066
Cutaneous metastasis of cholangiocarcinoma
Min Liu, Bai-Long Liu, Bin Liu, Liang Guo, Qiang Wang, Yan-Qiu Song, Li-Hua Dong
Min Liu, Bai-Long Liu, Qiang Wang, Li-Hua Dong, Department of Radiation Oncology, the First Hospital, Jilin University, Changchun 130021, Jilin Province, China
Bin Liu, Department of Hand Surgery, the First Hospital, Jilin University, Changchun 130021, Jilin Province, China
Liang Guo, Department of Pathology, the First Hospital, Jilin University, Changchun 130021, Jilin Province, China
Yan-Qiu Song, Cancer Center, the First Hospital, Jilin University, Changchun 130021, Jilin Province, China
Author contributions: Liu M was a major contributor in writing the manuscript; Liu BL revised it critically; Liu B, Guo L, Wang Q and Song YQ contributed to data analysis; Dong L reviewed the literature, analyzed the data, and gave final approval of the paper to be submitted; all authors read and approved the final manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Li-Hua Dong, MD, PhD, Department of Radiation Oncology, the First Hospital, Jilin University, 71 Xinmin Street, Changchun 130021, Jilin Province, China. lijie200461@126.com
Telephone: +86-431-88782468 Fax: +86-431-88786172
Received: September 27, 2014
Peer-review started: September 30, 2014
First decision: October 14, 2014
Revised: November 7, 2014
Accepted: December 5, 2014
Article in press: December 8, 2014
Published online: March 14, 2015
Processing time: 170 Days and 0.3 Hours
Abstract

AIM: To investigate the clinical characteristics and prognostic factors of cutaneous metastasis of cholangiocarcinoma by a retrospective analysis of published cases.

METHODS: An extensive search was conducted in the English literature within the PubMed database using the following keywords: cutaneous metastasis or skin metastasis and cholangiocarcinoma or bile duct. The data of 30 patients from 21 articles from 1978 to 2014 were analyzed. Patient data retrieved from the articles included the following: age, gender, time cutaneous metastasis occurred, number of cutaneous metastases throughout life, sites of initial cutaneous metastasis, anatomic site, pathology and differentiation of cholangiocarcinoma, and immunohistochemical results of the cutaneous metastasis. The assessment of overall survival after cutaneous metastasis (OSCM) was the primary endpoint.

RESULTS: The median age at diagnosis of cutaneous metastasis of cholangiocarcinoma was 60.0 years (range: 35-77). This metastasis showed a predilection towards males, with a male to female ratio of 3.29. In 8 cases (27.6%), skin metastasis was the first sign of cholangiocarcinoma. Additionally, 18 cases (60.0%) manifested single cutaneous metastasis, while 12 cases (40.0%) demonstrated multiple skin metastases. In 50.0% of patients, the metastasis occurred in the drainage region, while 50.0% of patients had distant cutaneous metastases. The scalp was the most frequently involved region of distant skin metastasis, occurring in 36.7% of patients. The median OSCM of cholangiocarcinoma was 4.0 mo. Patient age and cutaneous metastatic sites showed no significant relation with OSCM, while male gender and single metastasis of the skin were associated with a poorer OSCM (hazard ratio: 0.168; P = 0.005, and hazard ratio: 0.296; P = 0.011, respectively).

CONCLUSION: The prognosis of cutaneous metastasis of cholangiocarcinoma is dismal. Both male gender and single skin metastasis are associated with a poorer OSCM.

Keywords: Cutaneous metastasis; Cholangiocarcinoma; Clinical characteristics; Pathological features; Prognosis

Core tip: Skin metastasis from internal malignancy is rare, especially from cholangiocarcinoma. The clinical characteristics and prognosis of the metastases are unclear and need to be further defined. We performed a systemic analysis of 30 cases in the English literature from 1978 to 2014 to expand our understanding of this condition. To the best of our knowledge, this is the first comprehensive analysis of cutaneous metastasis of cholangiocarcinoma.