S0028 A Systematic Review of Cholangiocarcinoma in Africa: Epidemiology, Management and Clinical Outcomes

Abstract

INTRODUCTION: Cholangiocarcinoma (CCA) is the second most common hepatic tumor and accounts for nearly 3% of gastrointestinal cancers globally. There are limited published data from the African continent. We therefore conducted a comprehensive systematic review on the epidemiology, management, and outcomes of CCA in Africa. METHODS: We searched PubMed, EMBASE, Web of Science and CINHAL from inception up to November 2019 for studies on CCA in Africa. Studies were included if they provided a quantitative measure of disease occurrence (prevalence, incidence) or mortality (survival, mortality rate), and had a quantitative association between risk factors and CCA. Descriptive data were expressed as numbers with proportions and Chi-squared test was used to compare proportions. P values < 0.05 were considered significant. RESULTS: We identified 201 studies, of which 11 met the inclusion criteria. These 11 studies were reported from 4 countries: Egypt (n = 6), Tunisia (n = 2), South Africa (n = 2), and Nigeria (n = 1), with a combined total of 1,125 patients. Ten studies reported patient characteristics, management and outcomes, while one study on patient characteristics only. Risk factors of CCA remain unclear, with most cases occurring in absence of known risk factors. The studies from Egypt showed that among patients with CCA, the proportion of males was statistically significantly higher than females. Studies from Tunisia, South Africa and Nigeria did not demonstrate this gender disparity. Chemotherapy treatment was mainly used for palliative treatment. Six studies showed patients underwent surgery for curative intent. The best median survival time reported was 36 months in patients who underwent surgery with curative intent. Two studies on palliative treatment of malignant biliary obstruction using a percutaneous transhepatic self-expanding metal stents, showed a median survival time of 7 months post-procedure and a 20% survival rate in six month. CONCLUSION: The known global major risk factors for CCA including primary sclerosing cholangitis, Clonorchis sinensis and Opisthorchis viverrini infestation are rare in an African setting. A significant gender disparity could not be demonstrated. Chemotherapy treatment was mainly used for palliative treatment. Surgical intervention was described in at least 6 studies as a curative modality of treatment. Diagnostic capabilities such as radiographic imaging and endoscopy are lacking across the African continent, which plays a role in accurate diagnoses.Figure 1.: Flow diagram of included and excluded studies.Figure 2.: Proportion of males and females among patients with cholangiocarcinoma.Table 3.: Summary of studies from systematic review.