Prospective surveillance for cholangiocarcinoma in unselected individuals with primary sclerosing cholangitisShow 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
2022-11-242022-11-242025-02-11Bibliographically approved