Warren Alpert Medical School of Brown University Providence, RI
Akwi W. Asombang, MD, MPH, FACG1, Nathaniel Chishinga, MBChB, MPH, PhD1, Alick Nkhoma, MBChB2, Jackson Chipaila, MBChB, MMED3, Bright Nsokolo, MBChB, MMED4, Martha Manda-Mapalo, MBChB5, Joao Filipe G. Montiero, PhD1, Lewis Banda, MBChB6, Kulwinder Dua, MD, DMSc, FRCP7; 1Warren Alpert Medical School of Brown University, Providence, RI; 2Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Staffordshire, England, United Kingdom; 3University Teaching Hospital, Lusaka, Lusaka, Zambia; 4Levy Mwanawasa University Teaching Hospital, Lusaka, Lusaka, Zambia; 5University of New Mexico, Alberquerque, NM; 6Cancer Disease Hospital, Lusaka, Lusaka, Lusaka, Zambia; 7Medical College of Wisconsin, Milwaukee, WI
Introduction: Cholangiocarcinoma (CCA) is the second most common hepatic tumor and accounts for nearly 3% of gastrointestinal cancers globally. There are limited published data from the African continent. We therefore conducted a comprehensive systematic review on the epidemiology, management, and outcomes of CCA in Africa. Methods: We searched PubMed, EMBASE, Web of Science and CINHAL from inception up to November 2019 for studies on CCA in Africa. Studies were included if they provided a quantitative measure of disease occurrence (prevalence, incidence) or mortality (survival, mortality rate), and had a quantitative association between risk factors and CCA. Descriptive data were expressed as numbers with proportions and Chi-squared test was used to compare proportions. P values < 0.05 were considered significant. Results: We identified 201 studies, of which 11 met the inclusion criteria. These 11 studies were reported from 4 countries: Egypt (n=6), Tunisia (n=2), South Africa (n=2), and Nigeria (n=1), with a combined total of 1,125 patients. Ten studies reported patient characteristics, management and outcomes, while one study on patient characteristics only. Risk factors of CCA remain unclear, with most cases occurring in absence of known risk factors. The studies from Egypt showed that among patients with CCA, the proportion of males was statistically significantly higher than females. Studies from Tunisia, South Africa and Nigeria did not demonstrate this gender disparity. Chemotherapy treatment was mainly used for palliative treatment. Six studies showed patients underwent surgery for curative intent. The best median survival time reported was 36 months in patients who underwent surgery with curative intent. Two studies on palliative treatment of malignant biliary obstruction using a percutaneous transhepatic self-expanding metal stents, showed a median survival time of 7 months post-procedure and a 20% survival rate in six month. Discussion: The known global major risk factors for CCA including primary sclerosing cholangitis, Clonorchissinensis and Opisthorchisviverrini infestation are rare in an African setting. A significant gender disparity could not be demonstrated. Chemotherapy treatment was mainly used for palliative treatment. Surgical intervention was described in at least 6 studies as a curative modality of treatment. Diagnostic capabilities such as radiographic imaging and endoscopy are lacking across the African continent, which plays a role in accurate diagnoses.
Figure 1 Flow diagram of included and excluded studies
Table 1 Summary of studies from systematic review
Figure 2 Proportion of males and females among patients with cholangiocarcinoma
Disclosures: Akwi Asombang indicated no relevant financial relationships. Nathaniel Chishinga indicated no relevant financial relationships. Alick Nkhoma indicated no relevant financial relationships. Jackson Chipaila indicated no relevant financial relationships. Bright Nsokolo indicated no relevant financial relationships. Martha Manda-Mapalo indicated no relevant financial relationships. Joao Filipe Montiero indicated no relevant financial relationships. Lewis Banda indicated no relevant financial relationships. Kulwinder Dua indicated no relevant financial relationships.