An Innovative Algorithm for Population-based Risk Stratification using ultrasound for periductal fibrosis-associated with CCA

Abstract

A recent study demonstrated that periductal fibrosis (PDF) of the bile duct is associated with the development of cholangiocarcinoma (CCA). Little is known about the factors leading to PDF.  The present study aimed to identify factors that associated with PDF among villagers in an endemic area for CCA in Thailand. This study utilized the data from a cohort study conducted in a rural area in Khon Kaen Province in the northeast of Thailand where CCA is common. PDF was diagnosed by a radiologist based on hepatobiliary ultrasonography. Multiple logistic regression was performed to investigate the relationship between various factors and PDF. The overall discrimination property of the final model was also examined using receiver operating characteristics (ROC) curve. Of 139 participants with a mean age of 55.52 (±11.4) years, 65.5% were female and 34.5% were male. The percentage of PDF was 45.3% (95%CI: 36.9 to 54.0). Multivariate analysis identified factors that were associated with PDF and presented as odds ratio (OR) and 95%CI. These were raw fish consumption (OR= 0.23, 95%CI: 0.05 to 1.08; p=0.062), ox-A1AT (OR=10.71, 95%CI: 2.01 to 59.99; p=0.005), Opisthorchis viverrini (Ov) antibody (increase every 10 unit) (OR=1.14, 95%CI: 1.01 to 1.22; p=0.001) and having a relative with CCA (OR= 0.25, 95%CI: 0.09 to 0.71; p=0.009). The area under the ROC curve of the final model was 76.5% (95%CI: 68.3 to 83.1). In conclusion, the presentation of Ov antibody level, ox-A1AT level, having relative with CCA and history of raw fish consumption, were associated with PDF. These factors might be useful for future study to formulate a predictive model.

Keywords: Periductal fibrosis, Cholangiocarcinoma, Opisthorchis viverrini infection, Raw fish consumption