CHOLANGIOCARCINOMA IN INDIVIDUALS WITH CHRONIC LIVER DISEASE IS DIAGNOSED EARLIER, LEADING TO BETTER PROGNOSIS

Introduction and Objectives: Cholangiocarcinoma (CCA) incidence and mortality are rising globally. Chronic liver diseases (CLD) are recognized risk factors. This study aimed to compare the clinical presentation and outcomes of CCA in patients with and without CLD, using data from the International CCA Registry. Patients and Methods: The international CCA Registry is a multicenter observational study enrolling cases from 54 centers across Latin America, Europe, and Asia (2010–2024). Results: Among 3,693 patients enrolled, 916 had CLD and 2,777 did not. Common CLD conditions were fatty liver disease, cirrhosis, viral hepatitis, and primary sclerosing cholangitis. Compared to non-CLD patients, those with CLD were more often male (69% vs. 53%), younger at diagnosis (63 vs. 66 years), and had higher rates of metabolic risk factors, alcohol use, and smoking. Intrahepatic CCA was more frequent in CLD patients (64% vs. 43%), whereas distal CCA was more common in non-CLD cases (20% vs. 9%). CLD patients had better performance status (ECOG 0: 53% vs. 35%), lower CA19-9 levels (59.0 vs. 134.5 U/mL), and more localized disease (56% vs. 48%). Curative-intent surgery was more frequent in the CLD group (59% vs. 48%), translating into longer median overall survival (12.3 vs. 11.0 months) and higher 5-year survival (OR = 1.67; p < 0.001). The benefit was especially evident in intrahepatic CCA. Treatment responses were comparable between groups. Conclusions: CCA is diagnosed at earlier stages in individuals with CLD, likely due to certain clinical surveillance, leading to better prognosis. Prospective validation and standardized surveillance protocols are warrant.