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Multicenter Study
. 2024 May 2;8(5):e0442.
doi: 10.1097/HC9.0000000000000442. eCollection 2024 May 1.

Surveillance MRI is associated with improved survival in patients with primary sclerosing cholangitis

Natassia Tan  1   2 , Natalie Ngu  2   3 , Thomas Worland  4 , Tanya Lee  5 , Tobie Abrahams  5 , Elliot Freeman  1 , Nicholas Hannah  6   7 , Kathryn Gazelakis  8 , Richie G Madden  9 , Kate D Lynch  9 , Zina Valaydon  8 , Siddharth Sood  6   7 , Anouk Dev  2   3 , Sally Bell  2   3 , Alexander J Thompson  5   7 , John Nik Ding  5   7 , Amanda J Nicoll  2   10 , Ken Liu  11 , Keval Pandya  11 , Paul Gow  4   7 , John Lubel  1   2 , William Kemp  1   2 , Stuart K Roberts  1   2 , Ammar Majeed  1   2
Affiliations
Multicenter Study

Surveillance MRI is associated with improved survival in patients with primary sclerosing cholangitis

Natassia Tan et al. Hepatol Commun. .

Abstract

Background: The benefits of regular surveillance imaging for cholangiocarcinoma in patients with primary sclerosing cholangitis (PSC) are unclear. Hence, we aimed to evaluate the impact of regular magnetic resonance cholangiopancreatography (MRCP) on outcomes of patients with PSC in Australia, where the practice of MRCP surveillance is variable.

Methods: The relationship between MRCP surveillance and survival outcomes was assessed in a multicenter, retrospective cohort of patients with PSC from 9 tertiary liver centers in Australia. An inverse probability of treatment weighting approach was used to balance groups across potentially confounding covariates.

Results: A total of 298 patients with PSC with 2117 person-years of follow-up were included. Two hundred and twenty patients (73.8%) had undergone MRCP surveillance. Regular surveillance was associated with a 71% reduced risk of death on multivariate weighted Cox analysis (HR: 0.29, 95% CI: 0.14-0.59, p < 0.001) and increased likelihood of having earlier endoscopic retrograde cholangiopancreatography from the date of PSC diagnosis in patients with a dominant stricture (p < 0.001). However, survival posthepatobiliary cancer diagnosis was not significantly different between both groups (p = 0.74). Patients who had surveillance of less than 1 scan a year (n = 41) had comparable survival (HR: 0.46, 95% CI 0.16-1.35, p = 0.16) compared to patients who had surveillance at least yearly (n = 172).

Conclusions: In this multicenter cohort study that employed inverse probability of treatment weighting to minimize selection bias, regular MRCP was associated with improved overall survival in patients with PSC; however, there was no difference in survival after hepatobiliary cancer diagnosis. Further prospective studies are needed to confirm the benefits of regular MRCP and optimal imaging interval in patients with PSC.

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Conflict of interest statement

Natassia Tan received grants from Dr Falk Pharma. Nicholas Hannah received grants from Eisai. Alexander Thompson advises and is on the speakers’ bureau for Gilead, AbbVie, and Roche. He advises Immunocore, Aligos, and Assembly Biosciences. John Ding is on the speakers’ bureau for Abbvie, Pfizer, Takeda, and Falk. Amanda Nicoll advises and is on the speakers’ bureau for Eisai and AstraZeneca. She advises Ipsen and Roche. John Lubel advises Gilead and CSL. He is on the speaker’s bureau for Norgine and Roche. The remaining authors have no conflicts to report.

Figures

None
Graphical abstract
FIGURE 1
FIGURE 1
(A) Weighted Kaplan-Meier curve for time to ERCP from PSC diagnosis*, (B) Weighted Kaplan-Meier curve for overall survival, (C) Weighted Kaplan-Meier curve for transplant-free survival, (D) Weighted Kaplan-Meier curve for survival post-cancer diagnosis. *Two ERCP dates are missing from the surveillance group. Abbreviations: ERCP indicate endoscopic retrograde cholangiopancreatography, IPTW; inverse probability treatment weighting, MRCP; magnetic resonance imaging with cholangiopancreatography, PSC; primary sclerosing cholangitis.
FIGURE 2
FIGURE 2
Cumulative incidence function curve using Fine-Gray competing risk analysis.
FIGURE 3
FIGURE 3
Kaplan-Meier curve for survival stratified by surveillance intervals. Abbreviations: IPTW; inverse probability treatment weighting, MRCP; magnetic resonance imaging with cholangiopancreatography, PSC; primary sclerosing cholangitis.
See this image and copyright information in PMC

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