To Örebro University

oru.seÖrebro University Publications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Prospective surveillance for cholangiocarcinoma in unselected individuals with primary sclerosing cholangitis
Department of Transplantation Surgery, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.
Department of Hepatology, Sahlgrenska University Hospital, Göteborg, Sweden.
Department of Hepatology, Akademiska University Hospital, Uppsala, Sweden.
Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden; Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden.
Show others and affiliations
2023 (English)In: Journal of Hepatology, ISSN 0168-8278, E-ISSN 1600-0641, Vol. 78, no 3, p. 604-613Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The evidence for hepatobiliary tumour surveillance in patients with primary sclerosing cholangitis (PSC) is scarce. This study aimed to prospectively evaluate cholangiocarcinoma (CCA) surveillance with yearly magnetic resonance imaging including cholangiopancreatography (MRI/MRCP) in a nationwide cohort.

METHODS: In total, 512 PS C patients from 11 Swedish hospitals were recruited. The study protocol included yearly clinical follow-ups, liver function tests and contrast-enhanced MRI/MRCP and carbohydrate antigen (CA) 19-9. Patients with severe/progressive bile duct changes on MRI/MRCP were further investigated with endoscopic retrograde cholangiopancreatography. Patients were followed for five years or until a diagnosis of CCA, liver transplantation (LT) and/or death. Risk factors associated with CCA were analysed with Cox regression.

RESULTS: Eleven patients (2%) were diagnosed with CCA, and two (.5%) with high-grade bile duct dysplasia. Severe/progressive bile duct changes on MRI/MRCP were detected in 122 patients (24%), of whom 10% had an underlying malignancy. The primary indication for LT (n=54) was biliary dysplasia in nine patients (17%) and end-stage liver disease in 45 patients (83%), of whom three patients (7%) had unexpected malignancy in the explants. The median survival for CCA patients was 13 months (3-22 months). Time to diagnosis of high-grade dysplasia and/or hepatobiliary malignancy was significantly associated with MRI/MRCP with severe/progressive bile duct changes hazard ratio (HR) 10.50 (95%CI 2.49-44.31) and increased levels of CA19-9 H R 1.00 (95%CI 1.00-1.01).

CONCLUSION: In an unselected cohort of PSC patients, yearly CA19-9 and MRI/MRCP surveillance followed by ERCP was ineffective in detecting cancer early enough to provide long-term survival. Given the low occurrence of CCA, studies on individualized strategies for follow-up and improved diagnostic methods for PSC-CCA are warranted.

IMPACT AND IMPLICATIONS: A prospective nationwide 5-year study was conducted to evaluate yearly surveillance with magnetic resonance imaging (MRI) and CA19-9 in patients with primary sclerosing cholangitis. Only 2% of the patients were diagnosed with cholangiocarcinoma during follow-up with a poor prognosis. This surveillance strategy was ineffective to detect cancer early enough to provide long-term survival.

Place, publisher, year, edition, pages
Elsevier, 2023. Vol. 78, no 3, p. 604-613
Keywords [en]
Cholangiocarcinoma, Inflammatory bowel disease, Magnetic resonance imaging, Surveillance, primary sclerosing cholangitis
National Category
Gastroenterology and Hepatology
Identifiers
URN: urn:nbn:se:oru:diva-102366DOI: 10.1016/j.jhep.2022.11.011ISI: 000953335300001PubMedID: 36410555Scopus ID: 2-s2.0-85147020031OAI: oai:DiVA.org:oru-102366DiVA, id: diva2:1713167
Funder
Swedish Cancer SocietyStockholm County Council
Note

Funding agency:

Cancer Research Funds of Radiumhemmet

Available from: 2022-11-24 Created: 2022-11-24 Last updated: 2025-02-11Bibliographically approved

Open Access in DiVA

No full text in DiVA

Other links

Publisher's full textPubMedScopus

Authority records

Nyhlin, Nils

Search in DiVA

By author/editor
Nyhlin, Nils
By organisation
School of Medical SciencesÖrebro University Hospital
In the same journal
Journal of Hepatology
Gastroenterology and Hepatology

Search outside of DiVA

GoogleGoogle Scholar

doi
pubmed
urn-nbn

Altmetric score

doi
pubmed
urn-nbn
Total: 36 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf