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

IF 2.5 3区医学 Q3 ONCOLOGY World Journal of Surgical Oncology Pub Date : 2024-10-31 DOI:10.1186/s12957-024-03573-5

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

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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.

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提高胆管癌术后存活率：制定外科手术策略，在流行病地区开展筛查计划。

背景：胆管癌筛查和护理计划（CASCAP）自 2013 年启动，旨在发现早期胆管癌并减少疾病死亡。然而，CASCAP 的临床效用仍不明确。在胆管癌流行的亚洲地区，比较治疗策略发生重大变化的2013年之前和之后两个时期的生存结果，并评估基于超声波的筛查项目的疗效：方法：对2002年至2021年期间接受根治性切除胆管癌的患者进行了单中心回顾性研究。比较了 2002 年至 2013 年（早期）和 2014 年至 2021 年（晚期）的患者特征和生存结果：共纳入1091例肝内（n = 624）或肝周（n = 467）胆管癌患者（早期，n = 658；后期，n = 433）。后期的 66 例（15.2%）患者由 CASCAP 转诊。早期疾病（0 期和 1 期）的发生率为 16.0% 对 29.1%（P，结论）：在研究期间，CCA 患者的术后生存率提高了一倍多。此外，晚期患者的早期发现率有所提高，手术切缘阴性率较高，生存率也有所改善。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

World Journal of Surgical Oncology ONCOLOGY-SURGERY

CiteScore

4.70

自引率

15.60%

发文量

362

审稿时长

3 months

期刊介绍： World Journal of Surgical Oncology publishes articles related to surgical oncology and its allied subjects, such as epidemiology, cancer research, biomarkers, prevention, pathology, radiology, cancer treatment, clinical trials, multimodality treatment and molecular biology. Emphasis is placed on original research articles. The journal also publishes significant clinical case reports, as well as balanced and timely reviews on selected topics. Oncology is a multidisciplinary super-speciality of which surgical oncology forms an integral component, especially with solid tumors. Surgical oncologists around the world are involved in research extending from detecting the mechanisms underlying the causation of cancer, to its treatment and prevention. The role of a surgical oncologist extends across the whole continuum of care. With continued developments in diagnosis and treatment, the role of a surgical oncologist is ever-changing. Hence, World Journal of Surgical Oncology aims to keep readers abreast with latest developments that will ultimately influence the work of surgical oncologists.