Improvement of Survival Outcomes of Cholangiocarcinoma by Ultrasonography Surveillance: Multicenter Retrospective Cohorts

Introduction Most cholangiocarcinoma (CCA) patients present with late stage of disease because of the difficulty to diagnosis at an early stage, resulting in poor survival of CCA patients. The Cholangiocarcinoma Screening and Care Program showed that ultrasound screening was an effective tool for detecting early stage CCA. This study aims to evaluate the survival outcome of patients diagnosed by ultrasound screening (US) compared to walk-in symptomatic patients. Methods 5-year survival rates (5-YSR) and median survival time (MST) of CCA were calculated using Log-Rank test. Multivariate analyses were performed for significant factors from univariate analyses. Results A total of 711 histologically proven CCA cases were examined including ultrasound screening and walk-in groups. The screening group having 5-YSR was 53.9%, and MST was of 67.2 months, while walk-in group, the 5-YSR was 21.9% and MST was 15.6 months ( p <0.001). In addition, multivariate analyses revealed that screening program was an independent factor to predict a good outcome of CCA patients when compared with walk-in group ( p = 0.014). Conclusion US is an effective tool for detecting early stage CCA leading to improve clinical outcome of CCA patients. Practically, US should be considered as a first tool for screening CCA in risk populations. Author Summary Most cholangiocarcinoma (CCA) patients in Thailand have poor survival due to late-stage detection and patients walk-in to hospital with any symptoms. This study purpose to evaluate the survival outcome of CCA patients diagnosed by ultrasound screening (US). We found that US provided early stage and improved survival of CCA patients. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The author(s) received no specific funding for this work. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethics statement and consent to participate This study was conducted based on the principles of Good Clinical Practice, the Declaration of Helsinki, and national laws and regulations about clinical studies. All processes of this study were accepted and approved by the Khon Kaen University Ethics Committee for Human Research under the reference number HE551404. The data underwent complete anonymization before our access. Information could not identify individual participants. Clinical data and medical records of patients were retrieved through only hospital number (HN). Clinical data and medical records for this study were accessed in 30 June 2021. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All relevant data are within the manuscript and its Supporting Information files.