Surveillance for hepatobiliary cancers in patients with primary sclerosing cholangitis

Ahmad Hassan Ali, James H. Tabibian, Navine Nasser-Ghodsi, Ryan J. Lennon, Thomas DeLeon, Mitesh J. Borad, Moira Hilscher, Marina G. Silveira, Elizabeth J. Carey, Keith Lindor

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Abstract

Primary sclerosing cholangitis (PSC) is a risk factor for cholangiocarcinoma (CCA) and gallbladder carcinoma (GBCa). Surveillance for GBCa is recommended, but the clinical utility of surveillance for other hepatobiliary cancers (HBCa) in PSC, namely CCA and hepatocellular carcinoma (HCC), remains unclear. We aimed to determine whether surveillance is associated with better survival after diagnosis of HBCa in patients with PSC. Medical records of PSC patients seen at the Mayo Clinic Rochester from 1995 to 2015 were reviewed. Patients were included if they had ≥1 year of follow-up and developed HBCa. Patients were categorized according to their surveillance status (abdominal imaging, carbohydrate antigen 19-9, and alpha-fetoprotein). The primary endpoints were HBCa recurrence, HBCa-related death, and all-cause mortality. Overall survival was assessed by the Kaplan-Meier survival method; HBCa-related survival was assessed using competing risk regression. Tests of significance were two-tailed, and a P value <0.05 was considered statistically significant. From 1995 to 2015, a total of 79 of 830 PSC patients were diagnosed with HBCa. Cumulative follow-up was 712 and 283 person-years pre- and post-HBCa diagnosis, respectively. Seventy-eight percent of patients (54/79) developed CCA, 21% (17/79) HCC, 6% (5/79) GBCa, 3% (2/79) both CCA and HCC, and 1% (1/79) both HCC and GBCa. Fifty-one percent (40/79) were under HBCa surveillance, and 49% (39/79) were not. Patients in the surveillance group had significantly higher 5-year overall survival (68% versus 20%, respectively; P < 0.001) and significantly lower 5-year probability of experiencing an HBCa-related adverse event (32% versus 75%, respectively; P < 0.001) compared with the no-surveillance group. Conclusion: This study demonstrates that HBCa surveillance significantly improves outcomes, including survival, in patients with PSC. (Hepatology 2018;67:2338-2351).

Original languageEnglish (US)
Pages (from-to)2338-2351
Number of pages14
JournalHepatology
Volume67
Issue number6
DOIs
StatePublished - Jun 1 2018

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Sclerosing Cholangitis
Cholangiocarcinoma
Neoplasms
Gallbladder
Survival
Hepatocellular Carcinoma
Carcinoma
alpha-Fetoproteins
Gastroenterology
Medical Records
Cause of Death
Carbohydrates

ASJC Scopus subject areas

  • Hepatology

Cite this

Ali, A. H., Tabibian, J. H., Nasser-Ghodsi, N., Lennon, R. J., DeLeon, T., Borad, M. J., ... Lindor, K. (2018). Surveillance for hepatobiliary cancers in patients with primary sclerosing cholangitis. Hepatology, 67(6), 2338-2351. https://doi.org/10.1002/hep.29730

Surveillance for hepatobiliary cancers in patients with primary sclerosing cholangitis. / Ali, Ahmad Hassan; Tabibian, James H.; Nasser-Ghodsi, Navine; Lennon, Ryan J.; DeLeon, Thomas; Borad, Mitesh J.; Hilscher, Moira; Silveira, Marina G.; Carey, Elizabeth J.; Lindor, Keith.

In: Hepatology, Vol. 67, No. 6, 01.06.2018, p. 2338-2351.

Research output: Contribution to journalArticle

Ali, AH, Tabibian, JH, Nasser-Ghodsi, N, Lennon, RJ, DeLeon, T, Borad, MJ, Hilscher, M, Silveira, MG, Carey, EJ & Lindor, K 2018, 'Surveillance for hepatobiliary cancers in patients with primary sclerosing cholangitis', Hepatology, vol. 67, no. 6, pp. 2338-2351. https://doi.org/10.1002/hep.29730
Ali AH, Tabibian JH, Nasser-Ghodsi N, Lennon RJ, DeLeon T, Borad MJ et al. Surveillance for hepatobiliary cancers in patients with primary sclerosing cholangitis. Hepatology. 2018 Jun 1;67(6):2338-2351. https://doi.org/10.1002/hep.29730
Ali, Ahmad Hassan ; Tabibian, James H. ; Nasser-Ghodsi, Navine ; Lennon, Ryan J. ; DeLeon, Thomas ; Borad, Mitesh J. ; Hilscher, Moira ; Silveira, Marina G. ; Carey, Elizabeth J. ; Lindor, Keith. / Surveillance for hepatobiliary cancers in patients with primary sclerosing cholangitis. In: Hepatology. 2018 ; Vol. 67, No. 6. pp. 2338-2351.
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abstract = "Primary sclerosing cholangitis (PSC) is a risk factor for cholangiocarcinoma (CCA) and gallbladder carcinoma (GBCa). Surveillance for GBCa is recommended, but the clinical utility of surveillance for other hepatobiliary cancers (HBCa) in PSC, namely CCA and hepatocellular carcinoma (HCC), remains unclear. We aimed to determine whether surveillance is associated with better survival after diagnosis of HBCa in patients with PSC. Medical records of PSC patients seen at the Mayo Clinic Rochester from 1995 to 2015 were reviewed. Patients were included if they had ≥1 year of follow-up and developed HBCa. Patients were categorized according to their surveillance status (abdominal imaging, carbohydrate antigen 19-9, and alpha-fetoprotein). The primary endpoints were HBCa recurrence, HBCa-related death, and all-cause mortality. Overall survival was assessed by the Kaplan-Meier survival method; HBCa-related survival was assessed using competing risk regression. Tests of significance were two-tailed, and a P value <0.05 was considered statistically significant. From 1995 to 2015, a total of 79 of 830 PSC patients were diagnosed with HBCa. Cumulative follow-up was 712 and 283 person-years pre- and post-HBCa diagnosis, respectively. Seventy-eight percent of patients (54/79) developed CCA, 21{\%} (17/79) HCC, 6{\%} (5/79) GBCa, 3{\%} (2/79) both CCA and HCC, and 1{\%} (1/79) both HCC and GBCa. Fifty-one percent (40/79) were under HBCa surveillance, and 49{\%} (39/79) were not. Patients in the surveillance group had significantly higher 5-year overall survival (68{\%} versus 20{\%}, respectively; P < 0.001) and significantly lower 5-year probability of experiencing an HBCa-related adverse event (32{\%} versus 75{\%}, respectively; P < 0.001) compared with the no-surveillance group. Conclusion: This study demonstrates that HBCa surveillance significantly improves outcomes, including survival, in patients with PSC. (Hepatology 2018;67:2338-2351).",
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AU - Tabibian, James H.

AU - Nasser-Ghodsi, Navine

AU - Lennon, Ryan J.

AU - DeLeon, Thomas

AU - Borad, Mitesh J.

AU - Hilscher, Moira

AU - Silveira, Marina G.

AU - Carey, Elizabeth J.

AU - Lindor, Keith

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N2 - Primary sclerosing cholangitis (PSC) is a risk factor for cholangiocarcinoma (CCA) and gallbladder carcinoma (GBCa). Surveillance for GBCa is recommended, but the clinical utility of surveillance for other hepatobiliary cancers (HBCa) in PSC, namely CCA and hepatocellular carcinoma (HCC), remains unclear. We aimed to determine whether surveillance is associated with better survival after diagnosis of HBCa in patients with PSC. Medical records of PSC patients seen at the Mayo Clinic Rochester from 1995 to 2015 were reviewed. Patients were included if they had ≥1 year of follow-up and developed HBCa. Patients were categorized according to their surveillance status (abdominal imaging, carbohydrate antigen 19-9, and alpha-fetoprotein). The primary endpoints were HBCa recurrence, HBCa-related death, and all-cause mortality. Overall survival was assessed by the Kaplan-Meier survival method; HBCa-related survival was assessed using competing risk regression. Tests of significance were two-tailed, and a P value <0.05 was considered statistically significant. From 1995 to 2015, a total of 79 of 830 PSC patients were diagnosed with HBCa. Cumulative follow-up was 712 and 283 person-years pre- and post-HBCa diagnosis, respectively. Seventy-eight percent of patients (54/79) developed CCA, 21% (17/79) HCC, 6% (5/79) GBCa, 3% (2/79) both CCA and HCC, and 1% (1/79) both HCC and GBCa. Fifty-one percent (40/79) were under HBCa surveillance, and 49% (39/79) were not. Patients in the surveillance group had significantly higher 5-year overall survival (68% versus 20%, respectively; P < 0.001) and significantly lower 5-year probability of experiencing an HBCa-related adverse event (32% versus 75%, respectively; P < 0.001) compared with the no-surveillance group. Conclusion: This study demonstrates that HBCa surveillance significantly improves outcomes, including survival, in patients with PSC. (Hepatology 2018;67:2338-2351).

AB - Primary sclerosing cholangitis (PSC) is a risk factor for cholangiocarcinoma (CCA) and gallbladder carcinoma (GBCa). Surveillance for GBCa is recommended, but the clinical utility of surveillance for other hepatobiliary cancers (HBCa) in PSC, namely CCA and hepatocellular carcinoma (HCC), remains unclear. We aimed to determine whether surveillance is associated with better survival after diagnosis of HBCa in patients with PSC. Medical records of PSC patients seen at the Mayo Clinic Rochester from 1995 to 2015 were reviewed. Patients were included if they had ≥1 year of follow-up and developed HBCa. Patients were categorized according to their surveillance status (abdominal imaging, carbohydrate antigen 19-9, and alpha-fetoprotein). The primary endpoints were HBCa recurrence, HBCa-related death, and all-cause mortality. Overall survival was assessed by the Kaplan-Meier survival method; HBCa-related survival was assessed using competing risk regression. Tests of significance were two-tailed, and a P value <0.05 was considered statistically significant. From 1995 to 2015, a total of 79 of 830 PSC patients were diagnosed with HBCa. Cumulative follow-up was 712 and 283 person-years pre- and post-HBCa diagnosis, respectively. Seventy-eight percent of patients (54/79) developed CCA, 21% (17/79) HCC, 6% (5/79) GBCa, 3% (2/79) both CCA and HCC, and 1% (1/79) both HCC and GBCa. Fifty-one percent (40/79) were under HBCa surveillance, and 49% (39/79) were not. Patients in the surveillance group had significantly higher 5-year overall survival (68% versus 20%, respectively; P < 0.001) and significantly lower 5-year probability of experiencing an HBCa-related adverse event (32% versus 75%, respectively; P < 0.001) compared with the no-surveillance group. Conclusion: This study demonstrates that HBCa surveillance significantly improves outcomes, including survival, in patients with PSC. (Hepatology 2018;67:2338-2351).

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