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Ultrasound surveillance for cholangiocarcinoma in an endemic area: A prove of survival benefits
Author(s) -
Siripongsakun Surachate,
Vidhyarkorn Sirachat,
Charuswattanakul Sirivipa,
Mekraksakit Poemlarp,
Sungkasubun Prakongboon,
Yodkhunnathum Nuphat,
Tangruangkiat Sutthirak,
Ritlumlert Napat,
Sricharunrat Thaniya,
Jaroenpatarapesaj Sirima,
Soonklang Kamonwan,
Kulthanmanusorn Ad,
Auewarakul Chirayu U,
Mahidol Chulabhorn
Publication year - 2018
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.14074
Subject(s) - medicine , cohort , hazard ratio , malignancy , ultrasound , stage (stratigraphy) , abdominal ultrasound , proportional hazards model , confidence interval , population , surgery , radiology , environmental health , paleontology , biology
Background and Aim Cholangiocarcinoma (CCA) is an aggressive malignancy with rapid progression and poor prognosis. Abdominal ultrasound surveillance may detect early‐stage malignancy and improve surgical outcome. However, little data exist on the benefits of abdominal ultrasound surveillance in populations at high risk for CCA development in an endemic area. This study compared survival outcomes of CCA patients recruited through abdominal ultrasound surveillance program and those presented to the hospital independent of surveillance. Methods The surveillance population‐based cohort was 4225 villagers in Northern Thailand, aged 30–60 years, who consented to a 5‐year abdominal ultrasound surveillance program, which included interval ultrasound examinations every 6 months. The non‐surveillance cohort was hospital‐based CCA patients diagnosed during April 2007 to November 2015. Numbers of operable tumors, percentages of R0 resection, and survival analyses were compared between the two cohorts. Results There were 48 and 192 CCA patients in the surveillance and the non‐surveillance cohorts, respectively. Of these, 37/48 (77.1%) and 22/192 (11.5%) were in an operable stage and R0 resections performed in 36/48 (97.3%) and 14/192 (63.6%), respectively. The median survival in each group was 31.8 and 6.7 months, respectively (with correction of lead time bias) ( P < 0.0001). By multivariate analysis, abdominal ultrasound surveillance (hazard ratio [HR] = 0.41; P = 0.012), operable stage (HR = 0.11; P < 0.001), and serum albumin ≥ 3.5 g/dL (HR = 0.42; P < 0.001) were significantly associated with decreased mortality, whereas size of CCA (HR = 1.11; P < 0.001), serum alanine aminotransferase > 40 IU/L (HR = 1.71; P = 0.017), and tumor recurrence (HR = 4.86; P = 0.017) were associated with increased mortality. Conclusion Abdominal ultrasound surveillance provided survival benefits and should be considered in areas highly endemic for CCA to reduce mortality.