Identification of Biliary Bile Acids in Patients with Benign Biliary Diseases, Hepatocellular Carcinoma and Cholangiocarcinoma

Bile acids are implicated as aetiological factors in many types of gastrointestinal tract cancer includingcholangiocarcinoma (CCA). Alterations in bile acid concentrations may affect the pathogenesis of these differenttypes of cancer. Our aim was to determine the bile acid profile in gallbladder bile from patients who underwentliver resection. Thirty-seven patients with cholangiocarcinoma, 5 with hepatocellular carcinoma, and 7 withbenign biliary diseases were studied. High pressure liquid chromatography was used to analyze conjugated andunconjugated bile acids. CCA patients with low (≤2 mg/dl) and high (>2 mg/dl) levels of total serum bilirubinhad significantly higher total bile acid and conjugated bile acid concentrations than the benign biliary diseasegroup. Markedly elevated levels of cholic and chenodeoxycholic acid were found in CCA cases with high levelsof total serum bilirubin. Concentrations of total bile acids and primary bile acid were correlated with serumcholesterol, bilirubin and ALP in CCA. Notably, correlation of the carcinoembryonic antigen, a tumor marker,was found with level of total bile acids and chenodeoxycholic acid. These findings suggest a different pattern ofbile acid concentration in cancer patients compared to patients with benign biliary diseases. Thus, accumulationof certain bile acids may be involved in carcinogenesis.