Ultrasound screening for cholangiocarcinoma could detect premalignant lesions and early-stage diseases with survival benefits: a population-based prospective study of 4,225 subjects in an endemic area

Abstract

BackgroundThailand has a high incidence of cholangiocarcinoma (CCA), particularly in the north and northeastern regions. Most CCA patients come at a late, unresectable stage and presently no optimal screening test for CCA has been established. We determined the prevalence of CCA in a remote northern village and explored if screening could lead to early detection and survival benefits.MethodsA 5-year population-based study was started in October, 2011 for consented Thai individuals, aged 30–60 years. The screening program comprised blood testing, stool examination and serial ultrasonography every 6 months.ResultsDuring the first 3 years, 4,225 eligible individuals were enrolled. CCA was detected in 32 patients, with a mean age of 51.9 years (41–62 years), and 21/32 cases were at a curative resectable stage. The prevalence rate of CCA was 165.7 per 100,000 and one- and two-year incidence rate was 236.7/100,000 and 520.7/100,000, respectively. One- and 2-year overall survival rates of CCA patients were 90.9 and 61.5 %, respectively. Prognosis was better in resectable cases with 100 % 1-year and 77.8 % 2-year survival rates. Interestingly, premalignant pathological lesions (stage 0) were identified in 11 cases with 100 % 3-year survival rate. Serum biomarkers and alkaline phosphatase were not sufficient to detect early-stage disease. In 22 patients, stool samples were positive for Opistorchis viverrini, based on polymerase chain reaction.ConclusionDetection of premalignant lesions and early-stage resectable CCA by ultrasonography resulted in improved clinical outcome. Ultrasonography should be offered as a first screening tool for CCA in an endemic area until other useful biological markers become available.

Elevated prevalence of Helicobacter species and virulence factors in opisthorchiasis and associated hepatobiliary disease

“…The International Agency for Research on Cancer of the World Health Organization classifies infection with the liver flukes O. viverrini and Clonorchis sinensis and with H. pylori as Group 1 carcinogens 4 . In northern and northeastern Thailand and Laos, infection with O. viverrini is the major risk for CCA 4 8 55 56 . Following initiation, oncogenesis appears to be promoted by cholestasis and chronic inflammation.…”

Hyperphosphatasemia in leiomyosarcoma of the uterus: Two case reports and a literature review

“…Elevation of serum ALP3 is observed in cases of bone fracture, hyperparathyroidism, hyperthyroidism, osteosarcoma, and bone metastasis . ALP has also been used as a tumor marker in cholangiocarcinoma, pancreatic head cancer, metastatic liver cancer, prostate cancer, and breast cancer . Osteosarcoma is known to show hyperphosphatasemia.…”

Infection with CagA+Helicobacter pyloriinduces epithelial to mesenchymal transition in human cholangiocytes

“…Infection with the fish-borne liver flukes, Opisthorchis viverrini and Clonorchis sinensis, as well as the infection with H. pylori are all classified as Group 1 carcinogens by the International Agency for Research on Cancer [6]. Opisthorchiasis is a major risk factor for cholangiocarcinoma in northeastern Thailand and Laos [6][7][8][9]. In addition to gastric disease, infection with species of Helicobacter causes hepatobiliary tract diseases that can resemble opisthorchiasis [5,8,9,11,12].…”

“…The International Agency for Research on Cancer of the World Health Organization classifies infection with the liver flukes O. viverrini and Clonorchis sinensis as well as H. pylori as Group 1 carcinogens [6]. In northern and northeastern Thailand and Laos, opisthorchiasis is the major documented risk factor for CCA [6][7][8][9]. Given the elevated prevalence of CCA in this region where infection with liver fluke prevails, and given evidence of linkages between infection by Helicobacter during opisthorchiasis, these two biological carcinogens together may orchestrate the pathogenesis of opisthorchiasis and bile duct cancer.…”