Advertisement

Intrahepatic Cholangiocarcinoma: Socioeconomic Discrepancies, Contemporary Treatment Approaches and Survival Trends from the National Cancer Database

  • Johannes Uhlig
  • Cortlandt M. Sellers
  • Charles Cha
  • Sajid A. Khan
  • Jill Lacy
  • Stacey M. Stein
  • Hyun S. KimEmail author
Health Services Research and Global Oncology
  • 65 Downloads

Abstract

Objective

The aim of this study was to evaluate socioeconomic discrepancies in current treatment approaches and survival trends among patients with intrahepatic cholangiocarcinoma (ICC).

Methods

The 2004–2015 National Cancer Database was retrospectively analyzed for histopathologically proven ICC. Treatment predictors were evaluated using multinomial logistic regression and overall survival via multivariable Cox models.

Results

Overall, 12,837 ICC patients were included. Multiple factors influenced treatment allocation, including age, education, comorbidities, cancer stage, grade, treatment center, and US state region (multivariable p < 0.05). The highest surgery rates were observed in the Middle Atlantic (28.7%) and lowest rates were observed in the Mountain States (18.4%). Decreased ICC treatment likelihood was observed for male African Americans with Medicaid insurance and those with low income (multivariable p < 0.05). Socioeconomic treatment discrepancies translated into decreased overall survival for patients of male sex (vs. female; hazard ratio [HR] 1.21, 95% confidence interval [CI] 1.16–1.26, p < 0.001), with low income (< $37,999 vs. ≥ $63,000 annually; HR 1.07, 95% CI 1.01–1.14, p = 0.032), and with Medicaid insurance (vs. private insurance; HR 1.13, 95% CI 1.04–1.23, p = 0.006). Both surgical and non-surgical ICC management showed increased survival compared with no treatment, with the longest survival for surgery (5-year overall survival for surgery, 33.5%; interventional oncology, 11.8%; radiation oncology/chemotherapy, 4.4%; no treatment, 3.3%). Among non-surgically treated patients, interventional oncology yielded the longest survival versus radiation oncology/chemotherapy (HR 0.73, 95% CI 0.65–0.82, p < 0.001).

Conclusions

ICC treatment allocation and outcome demonstrated a marked variation depending on socioeconomic status, demography, cancer factors, and US geography. Healthcare providers should address these discrepancies by providing surgery and interventional oncology as first-line treatment to all eligible patients, with special attention to the vulnerable populations identified in this study.

Notes

Author Contributions

Conceptualization: JU, HSK. Methodology: JU. Validation: JU, HSK. Formal analysis: JU. Investigation: JU, CMS, HSK. Resources: CC, JL, SMS, HSK. Data curation: JU, CMS, HSK. Writing of the original draft: JU, CMS, CC, SAK, JL, SMS, HSK. Visualization: JU. Supervision: HSK. Project administration: CC, SAK, JL, SMS, HSK.

DISCLOSURE

Johannes Uhlig, Cortlandt M. Sellers, Charles Cha, Sajid A. Khan, Jill Lacy, Stacey M. Stein, and Hyun S. Kim have no conflicts of interest to declare.

Supplementary material

10434_2019_7175_MOESM1_ESM.docx (5.2 mb)
Supplementary material 1 (DOCX 5328 kb)

References

  1. 1.
    Patel T. Increasing incidence and mortality of primary intrahepatic cholangiocarcinoma in the United States. Hepatology. 2001;33(6):1353–57.CrossRefGoogle Scholar
  2. 2.
    Shaib Y, El-Serag HB. The epidemiology of cholangiocarcinoma. Semin Liver Dis. 2004;24(2):115–25.CrossRefGoogle Scholar
  3. 3.
    Vauthey JN, Blumgart LH. Recent advances in the management of cholangiocarcinomas. Semin Liver Dis. 1994;14(2):109–14.CrossRefGoogle Scholar
  4. 4.
    DeOliveira ML, Cunningham SC, Cameron JL, et al. Cholangiocarcinoma: thirty-one-year experience with 564 patients at a single institution. Ann Surg. 2007;245(5):755–62.CrossRefGoogle Scholar
  5. 5.
    Khan SA, Taylor-Robinson SD, Toledano MB, Beck A, Elliott P, Thomas HC. Changing international trends in mortality rates for liver, biliary and pancreatic tumours. J Hepatol. 2002;37(6):806–13.CrossRefGoogle Scholar
  6. 6.
    Yao KJ, Jabbour S, Parekh N, Lin Y, Moss RA. Increasing mortality in the United States from cholangiocarcinoma: an analysis of the National Center for Health Statistics Database. BMC Gastroenterol. 2016;16:117.CrossRefGoogle Scholar
  7. 7.
    Esnaola NF, Meyer JE, Karachristos A, Maranki JL, Camp ER, Denlinger CS. Evaluation and management of intrahepatic and extrahepatic cholangiocarcinoma. Cancer. 2016;122(9):1349–69.CrossRefGoogle Scholar
  8. 8.
    Khan SA, Davidson BR, Goldin R, et al. Guidelines for the diagnosis and treatment of cholangiocarcinoma: consensus document. Gut. 2002;51 Suppl 6:Vi1–9.Google Scholar
  9. 9.
    Jarnagin WR, Shoup M. Surgical management of cholangiocarcinoma. Semin Liver Dis. 2004;24(2):189–99.CrossRefGoogle Scholar
  10. 10.
    Valle J, Wasan H, Palmer DH, et al. Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer. N Engl J Med. 2010;362(14):1273–81.CrossRefGoogle Scholar
  11. 11.
    Konstantinidis IT, Arkadopoulos N, Ferrone CR. Surgical management of intrahepatic cholangiocarcinoma in the modern era: advances and challenges. Chin Clin Oncol. 2016;5(1):9.Google Scholar
  12. 12.
    Dwyer-Lindgren L, Flaxman AD, Ng M, Hansen GM, Murray CJ, Mokdad AH. Drinking patterns in US counties from 2002 to 2012. Am J Public Health. 2015;105(6):1120–7.CrossRefGoogle Scholar
  13. 13.
    Yoon Y-H, Chen CM. Surveillance report #105: Liver cirrhosis mortality in the United States: national, state, and regional trends, 20002013. Arlington, VA. Department of Health and Human Services, Public Health Service, National Institutes of Health; 2016.Google Scholar
  14. 14.
    Overweight and 0besity. 2018. https://www.cdc.gov/obesity/index.html.
  15. 15.
    Younossi ZM, Stepanova M, Afendy M, et al. Changes in the prevalence of the most common causes of chronic liver diseases in the United States from 1988 to 2008. Clin Gastroenterol Hepatol. 2011;9(6):524–30.e521; quiz e560.CrossRefGoogle Scholar
  16. 16.
    Sarmiento JM, Nagorney DM. Hepatic resection in the treatment of perihilar cholangiocarcinoma. Surg Oncol Clin N Am. 2002;11(4):893–908, viii–ix.CrossRefGoogle Scholar
  17. 17.
    Lewis CE, Smith E, Kercher C, Spitznagel E. Predictors of mortality in alcoholic men: a 20-year follow-up study. Alcohol Clin Exp Res. 1995;19(4):984–91.CrossRefGoogle Scholar
  18. 18.
    Leyland AH, Dundas R, McLoone P, Boddy FA. Cause-specific inequalities in mortality in Scotland: two decades of change. A population-based study. BMC Public Health. 2007;7:172.CrossRefGoogle Scholar
  19. 19.
    Najman JM, Williams GM, Room R. Increasing socioeconomic inequalities in male cirrhosis of the liver mortality: Australia 1981–2002. Drug Alcohol Rev. 2007;26(3):273–8.CrossRefGoogle Scholar
  20. 20.
    Jepsen P, Vilstrup H, Andersen PK, Sorensen HT. Socioeconomic status and survival of cirrhosis patients: a Danish nationwide cohort study. BMC Gastroenterol. 2009;9:35.CrossRefGoogle Scholar
  21. 21.
    Pinter M, Trauner M, Peck-Radosavljevic M, Sieghart W. Cancer and liver cirrhosis: implications on prognosis and management. ESMO Open. 2016;1(2):e000042.CrossRefGoogle Scholar
  22. 22.
    Arpey NC, Gaglioti AH, Rosenbaum ME. How socioeconomic status affects patient perceptions of health care: a qualitative study. J Prim Care Commun Health. 2017;8(3):169–75.CrossRefGoogle Scholar
  23. 23.
    Kullgren JT, Galbraith AA, Hinrichsen VL, et al. Health care use and decision-making among lower-income families in high-deductible health plans. Arch Intern Med. 2010;170(21):1918–25.CrossRefGoogle Scholar
  24. 24.
    Hibbard JH, Cunningham PJ. How engaged are consumers in their health and health care, and why does it matter? Res Brief. 2008;8:1–9.Google Scholar
  25. 25.
    Trivedi AN, Rakowski W, Ayanian JZ. Effect of cost sharing on screening mammography in Medicare health plans. N Engl J Med. 2008;358(4):375–83.CrossRefGoogle Scholar
  26. 26.
    Trivedi AN, Moloo H, Mor V. Increased ambulatory care copayments and hospitalizations among the elderly. N Engl J Med. 2010;362(4):320–8.CrossRefGoogle Scholar
  27. 27.
    Nakeeb A, Tran KQ, Black MJ, et al. Improved survival in resected biliary malignancies. Surgery. 2002;132(4):555–63; discission 563–554.CrossRefGoogle Scholar
  28. 28.
    Bridgewater J, Galle PR, Khan SA, et al. Guidelines for the diagnosis and management of intrahepatic cholangiocarcinoma. J Hepatol. 2014;60(6):1268–89.CrossRefGoogle Scholar
  29. 29.
    Shindoh J. Ablative therapies for intrahepatic cholangiocarcinoma. Hepatobil Surg Nutr. 2017;6(1):2–6.CrossRefGoogle Scholar
  30. 30.
    Zhang SJ, Hu P, Wang N, et al. Thermal ablation versus repeated hepatic resection for recurrent intrahepatic cholangiocarcinoma. Ann Surg Oncol. 2013;20(11):3596–602.CrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Johannes Uhlig
    • 1
    • 2
  • Cortlandt M. Sellers
    • 1
  • Charles Cha
    • 3
    • 4
  • Sajid A. Khan
    • 3
    • 4
  • Jill Lacy
    • 4
    • 5
  • Stacey M. Stein
    • 4
    • 5
  • Hyun S. Kim
    • 1
    • 4
    • 5
    Email author
  1. 1.Division of Interventional Radiology, Department of Radiology and Biomedical ImagingYale School of MedicineNew HavenUSA
  2. 2.Department of Diagnostic and Interventional RadiologyUniversity Medical Center GoettingenGoettingenGermany
  3. 3.Division of Surgical Oncology, Department of SurgeryYale School of MedicineNew HavenUSA
  4. 4.Yale Cancer CenterYale School of MedicineNew HavenUSA
  5. 5.Division of Medical Oncology, Department of MedicineYale School of MedicineNew HavenUSA

Personalised recommendations