Top

Published in:

01-07-2019 | Cholangiocarcinoma | Health Services Research and Global Oncology

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

Authors: Johannes Uhlig, MD MPH, Cortlandt M. Sellers, BS, Charles Cha, MD, Sajid A. Khan, MD, Jill Lacy, MD, Stacey M. Stein, MD, Hyun S. Kim, MD

Published in: Annals of Surgical Oncology | Issue 7/2019

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.

Available only for authorised users

Patel T. Increasing incidence and mortality of primary intrahepatic cholangiocarcinoma in the United States. Hepatology. 2001;33(6):1353–57.CrossRefPubMed

Shaib Y, El-Serag HB. The epidemiology of cholangiocarcinoma. Semin Liver Dis. 2004;24(2):115–25.CrossRefPubMed

Vauthey JN, Blumgart LH. Recent advances in the management of cholangiocarcinomas. Semin Liver Dis. 1994;14(2):109–14.CrossRefPubMed

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.CrossRefPubMedPubMedCentral

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.CrossRefPubMed

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.CrossRefPubMedPubMedCentral

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.CrossRefPubMed

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.PubMedPubMedCentral

Jarnagin WR, Shoup M. Surgical management of cholangiocarcinoma. Semin Liver Dis. 2004;24(2):189–99.CrossRefPubMed

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.CrossRefPubMed

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.PubMed

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.CrossRefPubMedPubMedCentral

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.

14.

Overweight and 0besity. 2018. https://www.cdc.gov/obesity/index.html.

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.CrossRefPubMed

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.CrossRefPubMed

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.CrossRefPubMed

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.CrossRefPubMedPubMedCentral

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.CrossRefPubMed

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.CrossRefPubMedPubMedCentral

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.CrossRefPubMedPubMedCentral

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.CrossRef

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.CrossRefPubMedPubMedCentral

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.

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.CrossRefPubMed

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.CrossRefPubMed

27.

Nakeeb A, Tran KQ, Black MJ, et al. Improved survival in resected biliary malignancies. Surgery. 2002;132(4):555–63; discission 563–554.CrossRefPubMed

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.CrossRefPubMed

29.

Shindoh J. Ablative therapies for intrahepatic cholangiocarcinoma. Hepatobil Surg Nutr. 2017;6(1):2–6.CrossRef

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.CrossRefPubMed

Title: Intrahepatic Cholangiocarcinoma: Socioeconomic Discrepancies, Contemporary Treatment Approaches and Survival Trends from the National Cancer Database
Authors: Johannes Uhlig, MD MPH
Cortlandt M. Sellers, BS
Charles Cha, MD
Sajid A. Khan, MD
Jill Lacy, MD
Stacey M. Stein, MD
Hyun S. Kim, MD
Publication date: 01-07-2019
Publisher: Springer International Publishing
Keywords: Cholangiocarcinoma
Cholangiocarcinoma
Cytostatic Therapy
Published in: Annals of Surgical Oncology / Issue 7/2019
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-019-07175-4

At a glance: The STEP trials

Springer Medicine

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

Abstract

Objective

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Objective

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 7/2019

Selection and Characteristics of Patients with Peritoneal Dissemination from Appendiceal Cancer with Exceptional/Poor Survival After CRS/HIPEC

A Single-Institution Validation Study of Lymph Node Staging By the AJCC 8th Edition for Patients with Pancreatic Head Cancer: A Proposal to Subdivide the N2 Category

The Prognosis of Papillary Thyroid Cancer with Initial Distant Metastasis is Strongly Associated with Extensive Extrathyroidal Extension: A Retrospective Cohort Study

Survival Benefit of the Surgical Management of Retroperitoneal Sarcoma in a Reference Center: A Nationwide Study of the French Sarcoma Group from the NetSarc Database

Prevention Therapy for Breast Cancer: How Can We Do Better?

Impact of Synchronous Versus Metachronous Onset of Colorectal Peritoneal Metastases on Survival Outcomes After Cytoreductive Surgery (CRS) with Hyperthermic Intraperitoneal Chemotherapy (HIPEC): A Multicenter, Retrospective, Observational Study