PDF(Pubmed)
Abstract：
BACKGROUND: Cholangiocarcinoma (CCA) is a highly fatal tumor, and the most favorable chance for long-term survival lies in curative resection. Periductal fibrosis (PDF), a precancerous condition associated with chronic inflammation of the bile ducts, can serve as a screening marker for CCA using hepatobiliary ultrasonography (US). However, limited studies have explored the relationship between PDF and CCA. This study aimed to investigate the association between PDF and CCA in a population at risk in Northeast Thailand.
METHODS: The study included participants enrolled in the Cholangiocarcinoma Screening and Care Program (CASCAP) between 2013 and 2021 who underwent US. Histological evaluations were conducted following the standard protocol of the tertiary hospital at Khon Kaen University, Thailand. PDF was defined as the presence of fibrosis in the peripheral (PDF1), segmental (PDF2), or main bile duct (PDF3), diagnosed by well-trained general practitioners or radiologists. The association between PDF and CCA was assessed using multiple logistic regression, calculating adjusted odds ratios (AORs) and 95% confidence intervals (CIs).
RESULTS: Out of 751,061 participants, the overall prevalence of PDF was 115,267 (15.35%), with an overall CCA rate of 0.11%. The rates of CCA were 0.1%, 0.15%, and 0.27% in participants with PDF1, PDF2, and PDF3, respectively. After adjusting for gender, age at enrollment, education levels, history of O. viverrini infection, smoking, and alcohol consumption, the AORs for CCA were 0.94 (95% CI: 0.74 - 1.20), 1.4 (95% CI: 1.03 - 1.91), and 2.52 (95% CI: 1.38 - 4.58) for participants with PDF1, PDF2, and PDF3, respectively.
CONCLUSIONS: Our findings demonstrate a significant association between fibrosis of the segmental and main bile ducts (PDF2 and PDF3) and CCA, with the strongest association observed in participants with PDF3. Hepatobiliary US screening could serve as a valuable tool for early detection of CCA, enabling timely curative treatment.
METHODS: The study included participants enrolled in the Cholangiocarcinoma Screening and Care Program (CASCAP) between 2013 and 2021 who underwent US. Histological evaluations were conducted following the standard protocol of the tertiary hospital at Khon Kaen University, Thailand. PDF was defined as the presence of fibrosis in the peripheral (PDF1), segmental (PDF2), or main bile duct (PDF3), diagnosed by well-trained general practitioners or radiologists. The association between PDF and CCA was assessed using multiple logistic regression, calculating adjusted odds ratios (AORs) and 95% confidence intervals (CIs).
RESULTS: Out of 751,061 participants, the overall prevalence of PDF was 115,267 (15.35%), with an overall CCA rate of 0.11%. The rates of CCA were 0.1%, 0.15%, and 0.27% in participants with PDF1, PDF2, and PDF3, respectively. After adjusting for gender, age at enrollment, education levels, history of O. viverrini infection, smoking, and alcohol consumption, the AORs for CCA were 0.94 (95% CI: 0.74 - 1.20), 1.4 (95% CI: 1.03 - 1.91), and 2.52 (95% CI: 1.38 - 4.58) for participants with PDF1, PDF2, and PDF3, respectively.
CONCLUSIONS: Our findings demonstrate a significant association between fibrosis of the segmental and main bile ducts (PDF2 and PDF3) and CCA, with the strongest association observed in participants with PDF3. Hepatobiliary US screening could serve as a valuable tool for early detection of CCA, enabling timely curative treatment.
摘要：
背景：胆管癌（CCA）是一种高度致命的肿瘤，最有利的长期生存机会在于根治性切除。导管周围纤维化(PDF),与胆管慢性炎症相关的癌前病变，可以使用肝胆超声检查（US）作为CCA的筛查标记。然而,有限的研究探讨了PDF和CCA之间的关系。这项研究旨在调查泰国东北部高危人群中PDF和CCA之间的关系。
方法：该研究包括在2013年至2021年期间参加胆管癌筛查和护理计划（CASCAP）并接受美国治疗的参与者。组织学评估是按照孔敬大学三级医院的标准方案进行的，泰国。PDF被定义为外周纤维化的存在（PDF1），分段(PDF2)，或主胆管（PDF3），由训练有素的全科医生或放射科医生诊断。使用多元逻辑回归评估PDF和CCA之间的关联，计算调整后的比值比(AORs)和95%置信区间(CIs)。
结果：在751,061名参与者中，PDF的总体患病率为115,267（15.35％），总体CCA率为0.11%。CCA率为0.1%，0.15%,PDF1、PDF2和PDF3参与者分别为0.27%。调整性别后，入学年龄，教育水平,O.Viverrini感染史,吸烟,和酒精消费，CCA的AOR为0.94(95%CI：0.74-1.20)，1.4（95%CI：1.03-1.91），PDF1，PDF2和PDF3参与者分别为2.52（95％CI：1.38-4.58）。
结论：我们的研究结果表明，节段和主胆管（PDF2和PDF3）的纤维化与CCA之间存在显着关联，在PDF3参与者中观察到最强的关联。肝胆US筛查可以作为早期发现CCA的有价值的工具，能够及时治疗。
方法：该研究包括在2013年至2021年期间参加胆管癌筛查和护理计划（CASCAP）并接受美国治疗的参与者。组织学评估是按照孔敬大学三级医院的标准方案进行的，泰国。PDF被定义为外周纤维化的存在（PDF1），分段(PDF2)，或主胆管（PDF3），由训练有素的全科医生或放射科医生诊断。使用多元逻辑回归评估PDF和CCA之间的关联，计算调整后的比值比(AORs)和95%置信区间(CIs)。
结果：在751,061名参与者中，PDF的总体患病率为115,267（15.35％），总体CCA率为0.11%。CCA率为0.1%，0.15%,PDF1、PDF2和PDF3参与者分别为0.27%。调整性别后，入学年龄，教育水平,O.Viverrini感染史,吸烟,和酒精消费，CCA的AOR为0.94(95%CI：0.74-1.20)，1.4（95%CI：1.03-1.91），PDF1，PDF2和PDF3参与者分别为2.52（95％CI：1.38-4.58）。
结论：我们的研究结果表明，节段和主胆管（PDF2和PDF3）的纤维化与CCA之间存在显着关联，在PDF3参与者中观察到最强的关联。肝胆US筛查可以作为早期发现CCA的有价值的工具，能够及时治疗。
