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Surveillance for liver, biliary cancer improves outcomes, survival in PSC

Surveillance for hepatobiliary cancers with imaging modality significantly improved outcomes and overall survival in patients with primary sclerosing cholangitis, according to recently published data.

“Patients with PSC are known to be at increased risk for hepatobiliary malignancy (HBCa); indeed, cholangiocarcinoma (CCA) and gallbladder carcinoma (GBCa) are feared complications of PSC,” Ahmad Hassan Ali, MBBS, from the Mayo Clinic, Arizona, and colleagues wrote. “Our findings establish the role of surveillance for detecting CCA, HCC, and GBCa in patients with PSC and will hopefully lay the basis for further studies.”

Ali and colleagues gathered data on patients diagnosed with PSC between 1995 and 2015 at their clinic with at least 1 year of follow-up. Seventy-nine patients developed hepatobiliary cancer (HBCa) during that period, 40 of whom had been under surveillance for HBCa.

Patients in the surveillance group had a significantly lower rate of adverse events (OR = 0.4; 95% CI, 0.21-0.76) compared with those without surveillance (OR = 3.4; 95% CI, 2.35-4.82). Univariate analysis demonstrated that surveillance correlated with better overall outcomes (HR = 0.18; 95% CI, 0.09-0.37). Among the 56 patients with cholangiocarcinoma (CCA), surveillance (HR = 0.26; 95% CI, 0.11-0.6) and cancer antigen 19-9 (HR = 1.24; 95% CI, 1.12-1.37) at the time of diagnosis independently predicted CCA-related adverse events.

Patients in the surveillance group also had a significantly lower rate of all-cause mortality (OR = 0.7; 95% CI, 0.39-1.08) compared with those without surveillance (OR = 3.8; 95% CI, 2.67-5.24). Compared with the surveillance group, mortality incidence was higher among those without surveillance at 5 years (68% vs. 56%; P < .001) and 10 years (20% vs. 13%; P < .001).

After multivariate analysis, surveillance status (HR = 0.3; 95% CI, 0.12-0.61) and CA 19-9 (HR = 1.18; 95% CI, 1.07-1.3) significantly predicted all-cause mortality in patients with CCA.

HBCa surveillance included at least one imaging modality (ultrasound, CT, or either MRI or magnetic resonance cholangiopancreatography) and CA 19-9. Results between those who underwent ultrasound and CT were significantly different (P = .008), whereas results from ultrasound and MRI or MRCP were similar.

“Despite the positive results of this study, the survival of patients with HBCa complicating PSC remains subsatisfactory, and better methods for earlier diagnosis of HBCa are needed,” Ali and colleagues wrote. “The role of traditional and novel tumor markers, cytological techniques, as well as cross-sectional imaging modalities should be better defined in a large-scale study including PSC patients with and without HBCa.” – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.