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

World J Surg Oncol. 2024 Oct 31;22(1):287. doi: 10.1186/s12957-024-03573-5.

Abstract

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.

Keywords: Cholangiocarcinoma; Cholangiocarcinoma Screening and Care Program; Screening program; Surgical strategies; Survival outcome.

MeSH terms

  • Aged
  • Bile Duct Neoplasms* / epidemiology
  • Bile Duct Neoplasms* / mortality
  • Bile Duct Neoplasms* / pathology
  • Bile Duct Neoplasms* / surgery
  • Cholangiocarcinoma* / epidemiology
  • Cholangiocarcinoma* / mortality
  • Cholangiocarcinoma* / pathology
  • Cholangiocarcinoma* / surgery
  • Early Detection of Cancer* / methods
  • Early Detection of Cancer* / statistics & numerical data
  • Female
  • Follow-Up Studies
  • Hepatectomy / mortality
  • Humans
  • Male
  • Middle Aged
  • Prognosis
  • Retrospective Studies
  • Survival Rate