Burden and risk factors of suspected cholangiocarcinoma in high Opisthorchis viverrini endemic rural communities in southern Lao PDR

by Anousin Homsana, Phonesavanh Southisavath, Kerstin Kling, Jan Hattendorf, Savina Vorasane, Daniel Henry Paris, Nicole Probst-Hensch, Somphou Sayasone, Peter Odermatt

Cholangiocarcinoma (CCA) is a major contributor to hepatobiliary mortality in the Lao People’s Democratic Republic (Lao PDR). Infection with the carcinogenic trematode Opisthorchis viverrini (OV), acquired through consumption of insufficiently-cooked river fish, is a known risk factor for the development of CCA. Together with OV, other risk factors contribute to the pathogenesis of CCA. We conducted this study to identify the burden of CCA and identify risk factors in high-risk communities in Lao PDR.

A cross-sectional study was performed in Champasack and Savannakhet provinces, southern Lao PDR, where OV infection is highly endemic. We assessed hepatobiliary morbidity with abdominal ultrasound (US). In addition, multiple risk factors known or suspected to be associated with CCA were assessed such as OV infection (examined by Kato-Katz technique for stool examination), lifestyle risks (e.g. smoking and alcohol consumption by face-to-face questionnaire), co-morbidity (e.g. diabetes mellitus) and hepatitis B infection status, both serologically tested.

In 3,400 participants, the overall prevalence of suspected CCA was 7.2% (95% confidence interval [95% CI] 5.4−9.6). The suspected CCA prevalence increased with age, and was higher in men at all ages. Almost all participants (88.3%) were infected with OV. In the multivariate regression analysis, suspected CCA was positively associated with OV infection (adjusted odds ratio [aOR] 3.4, 95% CI 1.7−6.5), and a history of cholecystectomy (aOR 2.7, 95% CI 1.5−4.9).

Our CCA screening in high OV prevalence rural areas of Lao PDR uncovers a high public health burden, primarily driven by elevated OV infection rates. Urgent interventions are needed to curb OV infection in these communities. Age and gender disparities in suspected CCA prevalence highlight the need for targeted efforts. Beyond OV, notable factors like a history of cholecystectomy offer valuable insights for preventive strategies. This research enhances our understanding of hepatobiliary morbidity and informs public health initiatives in Lao PDR.