Trilianos Panagiotis, Selaru Florin, Li Zhiping, Gurakar Ahmet
Division of Gastroenterology and Hepatology, Transplant Hepatology Section, The Johns Hopkins School of Medicine, Baltimore, Md., USA.
Digestion. 2014;89(2):165-73. doi: 10.1159/000357445. Epub 2014 Feb 22.
Cholangiocarcinoma (CCA) is the most common hepatobiliary malignancy complicating primary sclerosing cholangitis (PSC). Unfortunately, timely diagnosis of CCA in PSC patients remains challenging.
To investigate the strategies among liver centers regarding pre-transplant screening for CCA in patients with PSC.
An online survey was returned from 46 US transplant centers, inquiring on the frequency of screening, the use of specific tests, or tactical approaches to high-grade dysplasia (HGD) or CCA.
Most centers screen their PSC patients for CCA prior to orthotopic liver transplantation (OLT) (89%). Serum carbohydrate antigen 19-9 and magnetic resonance cholangiopancreatography are first-line screening tools (93 and 84% respectively). Endoscopic retrograde cholangiopancreatography with biliary brushings is routinely performed in only 30% of the centers. In the case of HGD, 61% would choose close monitoring. In the event of non-resectable CCA, 37% have an OLT protocol, 33% resort to palliative treatment and the remaining 30% make an outside referral. Finally, half the participating centers perform CCA surveillance among their listed PSC patients every 6 months.
Screening for CCA among PSC patients prior to OLT varies greatly among centers. Serum carbohydrate antigen 19-9 and magnetic resonance cholangiopancreatography are widely used. HGD warrants surveillance rather than intervention among most experts. Protocolized chemoradiation followed by OLT has yet to become a widely accepted approach. The very poor survival of PSC patients who develop CCA underlines the importance of an effective and universally accepted screening process that will aid in its earlier detection.
胆管癌（CCA）是原发性硬化性胆管炎（PSC）最常见的肝胆恶性并发症。不幸的是，及时诊断PSC患者中的CCA仍然具有挑战性。
探讨各肝脏中心对PSC患者进行移植前CCA筛查的策略。
对46个美国移植中心进行了一项在线调查，询问筛查频率、特定检查的使用情况，或针对高级别发育异常（HGD）或CCA的策略方法。
大多数中心在原位肝移植（OLT）前对其PSC患者进行CCA筛查（89%）。血清糖类抗原19-9和磁共振胰胆管造影是一线筛查工具（分别为93%和84%）。仅30%的中心常规进行带胆管刷检的内镜逆行胰胆管造影。对于HGD，61%会选择密切监测。对于不可切除的CCA，37%有OLT方案，33%采取姑息治疗，其余30%进行外部转诊。最后，一半的参与中心每6个月对其登记的PSC患者进行CCA监测。
各中心对OLT前PSC患者进行CCA筛查的情况差异很大。血清糖类抗原19-9和磁共振胰胆管造影被广泛使用。大多数专家认为HGD需要监测而非干预。先进行标准化放化疗再进行OLT尚未成为一种被广泛接受的方法。发生CCA的PSC患者生存情况极差，这凸显了有效且被普遍接受的筛查流程对于早期发现该病的重要性。
