Cholangiocarcinoma In Thailand Research Articles

Clinical Characteristics and Treatment Outcomes of Patients with Unresectable Cholangiocarcinoma in Thailand: Are there Differences Dependent on Stent Type?

Cholangiocarcinoma, though very rare in Western countries, is one of the commonest liver malignancies in Southeast Asia, especially in Thailand. More than half of the patients present with advanced stage disease. Given the poor treatment outcomes of adjuvant therapeutic options, many patients undergo only biliary drainage for palliative treatment. Clinical characteristics and treatment outcomes after biliary stenting were here analyzed for a total of 224 unresectable cholangiocarcinoma cases, 58.9% in men. The mean age was 61.5 years. Hilar involvement was the most common location. The patients underwent biliary drainage using plastic and metallic stents equally, early stent occlusion being encountered in 21.4% and 10.7%, respectively. The median survival time was 4.93 months for patients who received plastic and 5.87 months for patients who received metallic stents.

Prevalence of OV Infection in Yasothon Province, Northeast Thailand

A liver fluke, Opisthorchis viverrrini (OV), is the major cause of the high incidence of cholangiocarcinoma in Thailand. The prevalence of OV infection remains high in various parts of the country, especially in Northeast Thailand and particularly in wetland rural areas where a large proportion of the community work in agriculture and continue the traditional practice of eating raw or undercooked cyprinoid fish products. The national control program seems to have had little impact in many of these areas, and it has been difficult to make precise assessments of the overall effectiveness of the program. This paper is the first report of prospective research project designed to monitor the impact of the national control program in rural communities located in a northeastern province and at high risk of OV infection. The participants in this initial survey were 1,569 villagers, aged 20-65 years, living in two subdistricts of Yasothon Province. Stool examinations showed that 38.68% were infected with OV. Males were slightly more likely to be infected than females, but the difference was not statistically significant. Infection was found to be positively associated with age in both males and females. The preliminary data indicate that the population selected for study is suitable for the purpose of the monitoring project.

Banking on the future: Biobanking for “omics” approaches to biomarker discovery for Opisthorchis-induced cholangiocarcinoma in Thailand

Cholangiocarcinoma (CCA) – bile duct cancer – is associated with late presentation, poses challenges for diagnosis, and has high mortality. These features t highlight the desperate need for biomarkers than can be measured early and in accessible body fluids such as plasma of people at risk for developing this lethal cancer. In this manuscript, we address previous limitations in the discovery stage of biomarker(s) for CCA and indicate how new generation of “omics” technologies could be used for biomarker discovery in Thailand. A key factor in the success of this biomarker program for CCA is the combination of cutting edge technology with strategic sample acquisition by a biorepositories.

Letter To The Editor: The Prevalence Of Hepatitis C Seropositive And Opisthorchiasis Among The Patients With Cholangiocarcinoma

Cholangiocarcinoma is the malignancy of the biliary duct system, originating in the liver and terminating at the ampulla of Vater. It is a tumor that arises from the intrahepatic or extrahepatic biliary epithelium. The etiology of most bile duct cancers remains undetermined. Presently, these malignant biliary tract diseases are common cancerous diseases among the people in the Southeast Asia, with the world highest prevalence at the northeastern Thailand and Laos (1). Concerning the pathogenesis, it has been suggested that longstanding inflammation, as with primary sclerosing cholangitis or chronic parasitic infection, could play a role by inducing hyperplasia, cellular proliferation, and, ultimately, malignant transformation (2). This carcinoma tends to grow slowly and to infiltrate the walls of the ducts, dissecting along tissue planes and leading to biliary tract obstruction. Opisthorchiasis, an important intestinal parasite infection with high prevalence in tropical countries, is proposed to be linked to the very high incidence rate of cholangiocarcinoma in the Northeast of Thailand (3). Liver fluke or Opisthorchis viverri is the corresponding pathogen for this infection (3). In addition to opisthorchiasis, hepatitis virus-associated chronic hepatitis or cirrhosis has recently been suggested to be involved in the pathogenesis of cholangiocarcinoma(4, 5). Here, we reported the prevalence of hepatitis C seropositive among the Thai patients with cholangiocarcinoma. We retrospectively reviewed on the medical records of all cholangiocarcinoma patients who admitted to King Chulalongkorn Memorial Hospital during year 1992 to 2001. In each case, the cholangiocarcinoma had been diagnosed from the final histopathological results. A total of 30 cases with known hepatitis C serology and stool examination result were selected for further prevalence study. The data collated from the records also included the sex and age of each patient. A total of 30 patients with cholangiocarcinoma, who admitted to King Chulalongkorn memorial Thailand during 1992 – 2001, with known hepatitis C serology was selected for further prevalence study. Of the total 30 cases (16 males and 14 females), the hepatitis C seropositive was found in 4 cases (2 males and 2 females, giving the total prevalence rate equaled to 13.3 % (12.5 % for male and 14.3 % for female). Concerning stool examination, opisthorchis viverrini eggs were detected in 2 cases (1 male and 1 female) giving the total prevalence rate equaled to 6.7 % (6.3 % for male and 7.1 % for female). All cases with opisthorchiasis also have hepatitis C seropositive. One of the relating risk for development of cholangiocarcinoma is chronic infection. According to the recent study of Donato et al (4) , HCV is a risk factor for cholangiocarcinoma. Here, we can demonstrate a high rate (13.3 %) of hepatitis C seropositive among the cholangiocarcinoma patients. This prevalence was about 5 times higher in comparison with the Thai local population (about 2.6 %)(6). These findings can state the high hepatitis C seropositive rate among the cholangiocarcinoma patients. In addition, the co-presentation of hepatitis C seropositive and opisthorchiasis in some cases also implies for a higher risk. Since the hepatitis C infection is believed to be one of the risk to development of the cholangiocarcinoma and both Letter To The Editor: The Prevalence Of Hepatitis C Seropositive And Opisthorchiasis Among The Patients With Cholangiocarcinoma 2 of 3 cholangiocarcinoma and hepatitis C infection are common in Thailand (1), the screening for hepatitis C, adding to the routine screening for liver fluke by stool examination, may be a useful strategy for decrease of the high rate of cholangiocarcinoma in Thailand. Further long-term study to study the relation of hepatitis C infection and cholangiocarcinoma is recommended.

The prevalence of hepatitis B seropositivity among patients with cholangiocarcinoma.

Cholangiocarcinoma is a malignancy of the biliary duct system. Presently, these malignant biliary tract diseases are common among the people in Southeast Asia, with the world's highest prevalence in northeastern Thailand and Laos. This carcinoma tends to grow slowly and to infiltrate the walls of the ducts, dissecting along tissue planes and leading to biliary tract obstruction. Recently, hepatitis virus-associated chronic hepatitis or cirrhosis has been suggested to be involved in the pathogenesis of cholangiocarcinoma. Here, we report the prevalence of hepatitis B seropositivity among Thai patients with cholangiocarcinoma. A total of 55 patients with cholangiocarcinoma, who were admitted to King Chulalongkorn Memorial Hospital, Thailand, during 1992-2001, with known hepatitis B serology was selected for further prevalence study. Of the 55 cases (32 males and 22 females), hepatitis B seropositivity was found in five cases (three males and two females), giving a total prevalence rate equal to 9.1% (9.4% for male and 9.2% for females). Since hepatitis B infection is believed to be a risk factor in the development of cholangiocarcinoma, and both cholangiocarcinoma and hepatitis B infection are common in Thailand, screening and vaccination for hepatitis B may be a useful strategy to decrease the high rate of cholangiocarcinoma in Thailand. Further long-term study to study the relation of hepatitis B infection and cholangiocarcinoma is recommended.

Hepatitis C virus genotypes in patients with hepatocellular carcinoma and cholangiocarcinoma in Thailand

The prevalences of infections with hepatitis C virus (HCV) and hepatitis B virus (HBV) were determined in 110 Thai patients with liver cancer, of whom 80 and 30 had histological diagnoses of hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA), respectively. Hepatitis B surface antigen was detected in 63·8% of HCC patients and 16·7% of those with CCA. Antibodies to HCV, detected by a third-generation enzyme immunoassay, were found in 11·3% of HCC patients and in no CCA patient. HCV ribonucleic acid (RNA) was detected by polymerase chain reaction in 6 anti-HCV positive patients, and also in 2 patients who had no detectable anti-HCV antibody. A total of 11 patients had evidence of HCV infection, 8 of whom were infected with HCV alone. HCV genotypes were determined in all 8 patients who had HCV RNA; genotype 3a was the most common (62·5%). These results demonstrate that, in Thailand where both HBV and HCV are endemic, HBV infection is still the most important risk factor for HCC, but HCV also has an important role in those without HBV infection. In addition, the genotypic distribution of HCV in HCC in Thailand is similar to that in the general population. No specific association between genotype 1b and HCC was observed.