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Ann Surg Oncol. 2019 Jul;26(7):1993-2000. doi: 10.1245/s10434-019-07175-4. Epub 2019 Jan 28.

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

Uhlig J1,2, Sellers CM1, Cha C3,4, Khan SA3,4, Lacy J4,5, Stein SM4,5, Kim HS6,7,8.

Author information

1
Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA.
2
Department of Diagnostic and Interventional Radiology, University Medical Center Goettingen, Goettingen, Germany.
3
Division of Surgical Oncology, Department of Surgery, Yale School of Medicine, New Haven, CT, USA.
4
Yale Cancer Center, Yale School of Medicine, New Haven, CT, USA.
5
Division of Medical Oncology, Department of Medicine, Yale School of Medicine, New Haven, CT, USA.
6
Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA. kevin.kim@yale.edu.
7
Yale Cancer Center, Yale School of Medicine, New Haven, CT, USA. kevin.kim@yale.edu.
8
Division of Medical Oncology, Department of Medicine, Yale School of Medicine, New Haven, CT, USA. kevin.kim@yale.edu.

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.

PMID:
30693451
DOI:
10.1245/s10434-019-07175-4

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