Improving postoperative survival in cholangiocarcinoma: development of surgical strategies with a screening program in the epidemic region

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2024年10月31日

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Vasin Thanasukarn,
Tharatip Srisuk,
Vor Luvira,
Theerawee Tipwaratorn,
Apiwat Jareanrat,
Krit Rattanarak,
Khanisara Kraphunpongsakul,
Natcha Khuntikeo,
Jarin Chindaprasirt,
Thanachai Sanlung,
Nittaya Chamadol,
Supinda Koonmee,
Prakasit Sa-Ngiamwibool,
Poramate Klanrit,
Arporn Wangwiwatsin,
Nisana Namwat,
Watcharin Loilome,
Nattha Muangritdech,
Piya Prajumwongs,
Nobuyuki Watanabe,
Tomoki Ebata,
Attapol Titapun

摘要

Background

The Cholangiocarcinoma Screening and Care Program (CASCAP) has been launched since 2013 to detect early-stage cholangiocarcinoma and reduce the disease death. However, the clinical utility of the CASCAP remains unclear. To compare survival outcomes between two time periods: before and after 2013, when significant changes in treatment strategies were implemented, and to evaluate the efficacy of the ultrasound-based screening program, in an Asian region endemic for cholangiocarcinoma.

Methods

A single-center retrospective review was conducted in curative-intended resection cholangiocarcinoma from 2002 to 2021. Patents characteristics and survival outcomes were compared between 2002 and 2013 (early period) and 2014 to 2021 (later period).

Results

A total of 1091 patients with intrahepatic (n = 624) or perihilar (n = 467) cholangiocarcinoma was included (early period, n = 658; later period, n = 433). Of 66 (15.2%) patients in the later period were referred by the CASCAP. The incidence of early-staged disease (Stage 0 and 1) was lower in early period compared to later period 16.0% versus 29.1% (p < 0.001); that of positive surgical margin was higher in early period 53.7% versus 40.0% (p < 0.001). A median survival time (MST) was 14 months in early and 40 months in later period (p < 0.001). Subgroup analysis by tumor location, the MST was 13 versus 60 months in early and late periods for intrahepatic tumor (p < 0.001), respectively. While MST in perihilar tumor was 18 versus 31 months in early and late periods(p < 0.001), respectively. By presentation, the MST was 51 vs. 38 months, respectively, with screening and usual presentation (p = 0.06).

Conclusion

Postoperative survival in CCA patients improved more than doubled during the study period. Moreover, the late period demonstrated enhanced early-stage detection, a higher rate of negative surgical margins, and improved survival outcomes.