Annual MRI for Patients With Primary Sclerosing Cholangitis Failed to Provide Long-Term Cholangiocarcinoma Survival Benefit

In unselected patients with primary sclerosing cholangitis, yearly surveillance by MRI including cholangiopancreatography (MRI/MRCP) followed by endoscopic retrograde cholangiopancreatography (ERCP) failed to detect cancer early enough to provide a long-term survival benefit.

Christina Villard, MD, Karolinska University Hospital, Stockholm, Sweden, and coauthors wrote, “Given the low occurrence of [cholangiocarcinoma], studies on individualized strategies for follow-up and improved diagnostic methods for [cholangiocarcinoma in patients with primary sclerosing cholangitis] are warranted.”

This prospective, nationwide study enrolled 512 patients with primary sclerosing cholangitis from 11 hospitals in Sweden. Patients were evaluated in yearly clinical follow-ups involving liver function tests, contrast-enhanced MRI/MRCP, and carbohydrate antigen 19-9. Those patients who had severe or progressive bile duct changes as seen on the MRI/MRCP also underwent ERCP. Follow-up lasted for 5-years, or until a diagnosis of cholangiocarcinoma, a liver transplantation, or death of the patient.

There was a total of 11 patients (2%) diagnosed with cholagiocarcinoma during the follow-up duration. There were severe or progressive bile duct changes in 122 patients (24%), and 10% of those patients had an underlying malignancy. The median survival for patients with cholangiocarcinoma was 13 months. Time to diagnosis was significantly associated with both an MRI/MRCP with severe or progressive bile duct changes and increased levels of carbohydrate antigen 19-9.

For this unselected cohort of patients with primary sclerosing cholangitis, yearly surveillance with carbohydrate antigen 19-9 and MRI/MRCP followed by ERCP was not effective in detecting cholangiocarcinoma early enough to provide long-term survival.

Dr Villard et al concluded, “Only 2% of the patients were diagnosed with cholangiocarcinoma during follow-up with a poor prognosis. This surveillance strategy was ineffective to detect cancer early enough to provide long-term survival.”

Source:

Villard C, Friss-Liby I, Rorsman F, et al. Prospective surveillance for cholangiocarcinoma in unselected individuals with primary sclerosing cholangitis. J Hepatol. Published online November 19, 2022. doi:10.1019/j.jhep.2022.11.011