Intrahepatic Cholangiocarcinoma: Socioeconomic Discrepancies, Contemporary Treatment Approaches and Survival Trends from the National Cancer Database
- 65 Downloads
The aim of this study was to evaluate socioeconomic discrepancies in current treatment approaches and survival trends among patients with intrahepatic cholangiocarcinoma (ICC).
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.
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).
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.
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.
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.
- 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
- 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
- 13.Yoon Y-H, Chen CM. Surveillance report #105: Liver cirrhosis mortality in the United States: national, state, and regional trends, 2000–2013. Arlington, VA. Department of Health and Human Services, Public Health Service, National Institutes of Health; 2016.Google Scholar
- 14.Overweight and 0besity. 2018. https://www.cdc.gov/obesity/index.html.
- 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