Prospective surveillance for cholangiocarcinoma in unselected individuals with primary sclerosing cholangitis
2023
Online
Elektronische Ressource
Background & Aims: The evidence for hepatobiliary tumour surveillance in patients with primary sclerosing cholangitis (PSC) is scarce. In this study, we aimed to prospectively evaluate cholangiocarcinoma (CCA) surveillance with yearly MRI with chol-angiopancreatography (MRI/MRCP) in a nationwide cohort.Methods: In total, 512 patients with PSC 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 5 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 (0.5%) 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 patients with CCA was 13 months (3-22 months). Time to diagnosis of high-grade dysplasia and/or hepatobiliary malignancy was significantly associated with severe/ progressive bile duct changes on MRI/MRCP (hazard ratio 10.50; 95% CI 2.49-44.31) and increased levels of CA19-9 (hazard ratio 1.00; 95% CI 1.00-1.01).Conclusion: In an unselected cohort of patients with PSC, yearly CA19-9 and MRI/MRCP surveillance followed by ERCP was ineffective in detecting cancer early enough to support long-term survival. Given the low occurrence of CCA, studies on indi-vidualised strategies for follow-up and improved diagnostic methods for PSC-related CCA are warranted.
Funding Agencies|Swedish Cancer Society; Stockholm County Council; Cancer Research Funds of Radiumhemmet
Titel: |
Prospective surveillance for cholangiocarcinoma in unselected individuals with primary sclerosing cholangitis
|
---|---|
Link: | |
Veröffentlichung: | 2023 |
Medientyp: | Elektronische Ressource |
DOI: | 10.1016.j.jhep.2022.11.011 |
Schlagwort: |
|
Sonstiges: |
|