Please fill the following forms if you want to help us improve our model, thank you.
The collected information will be ONLY used for research!

Note: field with stars (*) is required!

*1. Race
White Yellow Black

2. Country/Area

3. Hospital

4. Patient's name

5. Patient's ID

*6. Age, mean (SD)

*7. Sex (F/M)
Male Female

8. Smoking
Yes No

9. Alcohol
Yes No

10. Personal cancer history
Yes No

11. Family cancer history
Yes No

12. Cholecystectomy
Yes No

13. Biliarytract surgery times

14. Total duration of IHL (year)

15. Inflammatory attacks within half a year (≥2 times)

*16. Comprehensive radiological diagnosis
No mass-related lesion found Inflammatory mass Suspicious of cancer Cancer

17. Location of hepatolithiasis
Left lobe Right lobe Left and right lobes Lobus caudatus

18. Lesion size (cm)

*19. Abdominal pain
Yes No

*20. Fever
Yes No

*21. Vomiting
Yes No

22. Jaundice
Yes No

23. Weight loss
Yes No

24. Ascites
Yes No

*25. ALK (U/L)

26. γ-GT (U/L)

27. ALT (U/L)

28. AST (U/L)

29. LDH (U/L)

30. Total bilirubin (mg/dl)

31. Albumin (g/dl)

32. PT (second)

33. INR (number)

*34. CA 19-9 (U/mL)

*35. CEA (μg/L)

36. AFP (μg/L)

37. CA 125 (U/ml)

38. HBsAg+
Yes No

39. HBcAb+
Yes No

40. HCV
Yes No

41. Diabetes
Yes No

42. Cirrhosis
Yes No

43. Fatty liver
Yes No

44. Please fill in other risk factors that you think

*45. Pathologic diagnosis
Intrahepatic biliary inflammation Intrahepatic cholangiocarcinoma

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