Yearly surveillance fails to detect cancer early in primary sclerosing cholangitis

In unselected patients with primary sclerosing cholangitis (PSC), yearly surveillance with carbohydrate antigen (CA) 19-9 and magnetic resonance imaging including cholangiopancreatography (MRI/MRCP) does not seem to increase the chances of detecting cancer early, a new study has found.

A total of 512 PSC patients participated in the prospective study, all of whom were subjected to yearly clinical follow-ups and liver function tests. Surveillance was conducted through contrast-enhanced MRI/MRCP and CA 19-9. Those found to have severe or progressive bile duct changes were sent for endoscopic retrograde cholangiopancreatography (ERCP).

A total of 122 patients (24 percent) showed such progressive changes in MRI/MRCI, of whom 10 percent were found to have underlying malignancies. Fifty-four patients were recommended for liver transplantation, the primary indication for which was end-stage liver disease (n=45; 83 percent).

Multivariate regression analysis revealed that severe or progressive changes detected in MRI/MRCP were significantly correlated with time to diagnosis of hepatobiliary malignancy (hazard ratio, 10.50, 95 percent confidence interval, 2.49–44.31).

However, over the 5-year follow-up period, 25 patients still died. Biliary tract malignancy was a leading cause of death (n=8; 32 percent).

“A surveillance program with yearly CA 19-9 and MRI/MRCP, followed by investigations with ERCP … in an unselected cohort of PSC patients, was ineffective in detecting cholangiocarcinoma (CCA) early enough to benefit survival,” the researchers said.

“Studies on individualized strategies for follow-up and improved diagnostic methods for PSC-CCA are warranted,” they added.