Abstract
BackgroundThailand has a high incidence of cholangiocarcinoma (CCA), particularly in the north and northeastern regions. Most CCA patients come at a late, unresectable stage and presently no optimal screening test for CCA has been established. We determined the prevalence of CCA in a remote northern village and explored if screening could lead to early detection and survival benefits.MethodsA 5-year population-based study was started in October, 2011 for consented Thai individuals, aged 30–60 years. The screening program comprised blood testing, stool examination and serial ultrasonography every 6 months.ResultsDuring the first 3 years, 4,225 eligible individuals were enrolled. CCA was detected in 32 patients, with a mean age of 51.9 years (41–62 years), and 21/32 cases were at a curative resectable stage. The prevalence rate of CCA was 165.7 per 100,000 and one- and two-year incidence rate was 236.7/100,000 and 520.7/100,000, respectively. One- and 2-year overall survival rates of CCA patients were 90.9 and 61.5 %, respectively. Prognosis was better in resectable cases with 100 % 1-year and 77.8 % 2-year survival rates. Interestingly, premalignant pathological lesions (stage 0) were identified in 11 cases with 100 % 3-year survival rate. Serum biomarkers and alkaline phosphatase were not sufficient to detect early-stage disease. In 22 patients, stool samples were positive for Opistorchis viverrini, based on polymerase chain reaction.ConclusionDetection of premalignant lesions and early-stage resectable CCA by ultrasonography resulted in improved clinical outcome. Ultrasonography should be offered as a first screening tool for CCA in an endemic area until other useful biological markers become available.
Highlights
Thailand has a high incidence of cholangiocarcinoma (CCA), in the north and northeastern regions
People with liver lesions suspected of liver cancer, such as isolated mass lesions, masses associated with bile duct dilatation, or isolated bile duct dilatation without mass lesions were referred for further imaging studies, including computed tomography (CT), magnetic resonance imaging (MRI) or magnetic resonance cholangiopancreatography (MRCP) at Chulabhorn Hospital
Demographic data of the cohort and prevalence and incidence of cholangiocarcinoma Between October 2011 and April 2014, abdominal ultrasonography was completed in 4,225 participants (1,919 males and 2,306 females) from 4,337 recruited participants
Summary
Thailand has a high incidence of cholangiocarcinoma (CCA), in the north and northeastern regions. We determined the prevalence of CCA in a remote northern village and explored if screening could lead to early detection and survival benefits. Cholangiocarcinoma is a tumor of the biliary tract, presumably of cholangiocytic origin, with a rising global incidence [1,2,3,4,5,6]. With a median survival of months, is noted in most patients in developing countries whereby cholangiocarcinoma is most prevalent. In the minority of patients and in those with large node-positive or multifocal intrahepatic cholangiocarcinoma, resection seems to provide little benefit [10, 12]. The 5-year survival in cholangiocarcinoma cases is poor, with 60 % to >90 % recurrence rates [7, 9, 13]
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