Ultrasound surveillance for cholangiocarcinoma in an endemic area: A prove of survival benefits

Siripongsakun, Surachate; Vidhyarkorn, Sirachat; Charuswattanakul, Sirivipa; Mekraksakit, Poemlarp; Sungkasubun, Prakongboon; Yodkhunnathum, Nuphat; Tangruangkiat, Sutthirak; Ritlumlert, Napat; Sricharunrat, Thaniya; Jaroenpatarapesaj, Sirima; Soonklang, Kamonwan; Kulthanmanusorn, Anond; Auewarakul, Chirayu; Mahidol, Chulabhorn

doi:10.1111/jgh.14074

Cited by 6 publications

(4 citation statements)

References 26 publications

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“…The distant stage was present at diagnosis in 43.5% patients with iCCA, and approximately 30% in dCCA and hiCCA. Recently, Siripongsakun et al (16) reported that surveillance by abdominal ultrasound (HR, 0.41; P=0.012) was significantly provided survival benefits, suggesting highly endemic areas for CCA to apply the surveillance system. In our point of view, the surveillance system is required not only in endemic areas, but also in all patients with known risk factors for the development of CCA, such as viral hepatitis and primary sclerosing cholangitis regarding extremely high mortality of CCA.…”

Section: Discussionmentioning

confidence: 99%

Cholangiocarcinoma: anatomical location-dependent clinical, prognostic, and genetic disparities

Hang¹,

Jeong²,

Meng³

et al. 2019

Ann Transl Med

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Background: Anatomical location is considered in diagnostic and therapeutic approaches of cholangiocarcinoma (CCA). However, disparities and its extents in proportion of surgical candidates, prognostic factors, prognostic genetic networks, susceptibility for lymph node dissection, and disease stage at diagnosis remain to be confirmed. Methods: A total of 11,710 patients with cholangiocarcinoma from Surveillance, Epidemiology, and End Results Cancer Registries (SEER) and 45 CCA patients with paired tumor and normal specimens from The Cancer Genome Atlas were studied. Kaplan-Meier estimation, Cox proportional hazards regression, Pearson's correlation, comparison between anatomical location (distal, intrahepatic, and perihilar)-dependent CCAs, differential expressive gene stratification, potential interactive gene identification, and confirmation on pathways of the prognostic networks were carried out.Results: Survival outcomes were most favorable in the distal type, followed by perihilar and intrahepatic types, but postsurgical prognosis was slightly higher in intrahepatic type compared to perihilar type. Distant historic stage at diagnosis was noticed in intrahepatic type. Significant prognostic factors and their hazards ratios were dependent to the anatomical location. In addition, lymph node dissection provided significant survival benefits in perihilar type only. Furthermore, prognosis-predictive genes, as well as potential processes and pathways, were significantly among the anatomical location-dependent types that the genes barely overlapped.Conclusions: There are disparities in almost all aspects among distal, intrahepatic, and perihilar CCAs.Anatomical location needs to be considered in treatment, prognostic estimation, identifying targets, and developing therapeutic approaches for CCA.

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Section: Discussionmentioning

confidence: 99%

Cholangiocarcinoma: anatomical location-dependent clinical, prognostic, and genetic disparities

Hang¹,

Jeong²,

Meng³

et al. 2019

Ann Transl Med

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“…Thus, ultrasound surveillance can help diagnose CCA at premalignant and early cancer stages (Sungkasubun et al, 2016). Also, in this long-term surveillance cohort, Siripongsakun et al, reported a survival benefit associated with using ultrasound for CCA surveillance (Siripongsakun et al, 2018), an increased median survival from 6.7 to 31.8 months.…”

Section: Research Articlementioning

confidence: 66%

“…The ultrasound surveillance group comprised patients in the cohort of the "Study and treatment project for CCA" of Chulabhorn Hospital at Bangluang district, Nan province, during 2011-2017. (Siripongsakun et al, 2018) Whereas, the non-ultrasound surveillance group included patients with treatment of CCA at Chulabhorn Hospital during 2009-2015. (Siripongsakun et al, 2018) Both group of the patients received major investigations and treatment including Computorised Tomography (CT), Magnetic Resonance Imaging (MRI), Percuateneous Biliary Drainage (PTBD), Hepatic resection and Chemotherapy at Chulabhorn hospital.…”

Section: Methodsmentioning

confidence: 99%

Cost-Effectiveness Analysis of Ultrasound Surveillance for Cholangiocarcinoma in an Endemic Area of Thailand

Laopachee,

Siripongsakun,

Sangmala

et al. 2023

Asian Pac J Cancer Prev

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Objective: This research aimed to analyze the cost-effectiveness of ultrasound surveillance for Cholangiocarcinoma (CCA) in a high-risk population residing in the northern region of Thailand and compare these results with the non-surveillance patients who presented with CCA. Methods: This was a retrospective descriptive study of two groups monitored and treated for CCA in the same institute, but differing as to whether ultrasound was included in the surveillance. The ultrasound surveillance group comprised those who participated in the cohort study of CCA at Chulabhorn Hospital from 2011 to 2017. Whereas, the non-ultrasound surveillance group consisted of patients treated for CCA at Chulabhorn Hospital from 2009 to 2015 (and not part of the first group). Historical data and societal perspectives were analyzed and interpreted using a decision tree model. The results of one-way sensitivity analyses of probability and cost parameters affecting the change in incremental cost-effectiveness ratio (ICER) were analyzed and presented using tornado diagrams. Result: The ultrasound surveillance group had the quality-adjusted life years gained (QALY gained) of 0.117 years, resulting in the incremental cost-effectiveness ratio (ICER) of 152,985 Thai Baht (THB) or equal to 4,222.6 US-dollars (USD) /QALY gained which is about when compared to the non-ultrasound surveillance group. Moreover, the ICER value was within the willingness to pay (WTP) calculated for Thailand of 4,416.2 USD (160,000 THB) /QALY gained. The probability of non-diagnostic CCA in non-ultrasound surveillance group and the cost of abdominal ultrasound were found to be major factors affecting the ICER. Conclusion: Ultrasound surveillance of CCA was cost-effective in Thailand. This information can be helpful for national policy planning in regard to Thai populations at high risk of CCA. Further study is recommended to assess cost-effectiveness in other areas with lower incidences of CCA.

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“…The results showed that 3-month US detection may find more small focal lesions than 6-months US detection, but does not improve detection rate of small HCC, nor improve the 5-year survival. The efficacy of US screening every 6 months for HCC or CC in a selective high risk group in endemic areas of hepatitis B such as in Thailand, Taiwan have been reported [72][73][74] .…”

Section: Us Could Be Used For Early Detectionmentioning

confidence: 99%

Liver cancer screening in China: practices and its extended questions

Chen¹,

Zhang²,

Lu³

et al. 2019

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Screening for liver cancer (hepatocellular carcinoma) in China started in early 1970s with the application of alphafetoprotein (AFP) in high-incidence regions. It has been extended to nationwide areas, emerging from the concepts of conducting screening in populations at-risk with positive hepatitis B surface antigen to the practice programs in rural and urban areas, and finally to the development of recommendations to guide medical practice for health care providers. The implementation of screening for liver cancer has resulted in earlier detection and hence the early curable treatment for patients who have gained short-or long-term survival, and even reduction in mortality rates, although these outcomes are more anecdotal than rigorously evidence-based. AFP or ultrasound examination has been considered as sensitive and specific methods for early detection but are with limitations. The combined use of these two modalities for screening populations at-risk every six months seems to have been reached consensus. The feasibility of screening for liver cancer is still debated because of differing opinions and even opposition to the choice of targeted sub-populations, the intrinsic necessity, and the contributions of the main risk factors among Western countries and China/Asian areas. Yet, the over 51% of global burden of liver cancer is in China, the solution to the early detection and treatment of liver cancer should fully consider the actual situation in China. The effectiveness of screening for liver cancer is worthy of anticipation.

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Ultrasound surveillance for cholangiocarcinoma in an endemic area: A prove of survival benefits

Abstract: Abdominal ultrasound surveillance provided survival benefits and should be considered in areas highly endemic for CCA to reduce mortality.

Cited by 6 publications

References 26 publications

Cholangiocarcinoma: anatomical location-dependent clinical, prognostic, and genetic disparities

Cholangiocarcinoma: anatomical location-dependent clinical, prognostic, and genetic disparities

Cost-Effectiveness Analysis of Ultrasound Surveillance for Cholangiocarcinoma in an Endemic Area of Thailand

Liver cancer screening in China: practices and its extended questions

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