TY - JOUR
T1 - Disparities in curative treatments and outcomes for early stage intrahepatic cholangiocarcinoma in the United States
AU - Lee, Yi Te
AU - Singal, Amit G.
AU - Lauzon, Marie
AU - Agopian, Vatche G.
AU - Luu, Michael
AU - Noureddin, Mazen
AU - Todo, Tsuyoshi
AU - Kim, Irene K.
AU - Friedman, Marc L.
AU - Kosari, Kambiz
AU - Nissen, Nicholas N.
AU - Roberts, Lewis R.
AU - Heimbach, Julie K.
AU - Gores, Gregory J.
AU - Yang, Ju Dong
N1 - Funding Information:
This work is supported by the American College of Gastroenterology (Junior Faculty Development Award), the US Department of Defense (Peer Reviewed Cancer Research Program Career Development Award CA191051), the Mayo Clinic, and the National Institutes of Health (R01MD012565).
Funding Information:
This study used the National Cancer Database. The authors acknowledge the efforts of the American College of Surgeons and the American Cancer Society for providing and maintaining the National Cancer Database and the efforts of the Commission on Cancer‐accredited facilities for collecting the clinical oncology data. This work is supported by the American College of Gastroenterology (Junior Faculty Development Award); the US Department of Defense (Peer Reviewed Cancer Research Program Career Development Award, CA191051); the Mayo Clinic; and the National Institutes of Health (R01MD012565).
Funding Information:
This study used the National Cancer Database. The authors acknowledge the efforts of the American College of Surgeons and the American Cancer Society for providing and maintaining the National Cancer Database and the efforts of the Commission on Cancer-accredited facilities for collecting the clinical oncology data. This work is supported by the American College of Gastroenterology (Junior Faculty Development Award); the US Department of Defense (Peer Reviewed Cancer Research Program Career Development Award, CA191051); the Mayo Clinic; and the National Institutes of Health (R01MD012565).
Funding Information:
Amit G. Singal reports personal fees from Exact Sciences, Roche, Genentech, Bayer, Eisai Inc., Bristol‐Myers Squibb, Exelixis Inc., FujiFilm Medical Systems USA, and AstraZeneca outside the submitted work. Mazen Noureddin reports research support from Allergan, Bristol‐Myers Squibb, Gilead, Galmed, Galectin, Genfit, Conatus, Enanta, Madrigal, Novartis, Pfizer, Shire, Viking, and Zydus; personal fees from 89BIO, Gilead, Intercept, Pfizer, Novo Nordisk, Blade, EchoSens, Fractyl, Terns, Siemens, and Roche Diagnostic; and is a minor shareholder or owns stock in Anaetos, Rivus Pharma. and Viking outside the submitted work. Lewis R. Roberts reports grant support from ARIAD Pharmaceuticals, Bayer, BTG International, Boston Scientific Corporation Exact Sciences, FujiFilm Medical Systems USA, Gilead Sciences, Glycotest Inc., Red Hill Biopharma Inc., TARGET PharmaSolutions, and Wako Diagnostics; and personal fees from AstraZeneca, Bayer, Eisai Inc., Exact Sciences, Genentech USA, Gilead Sciences, GRAIL, Inc., Hepion Pharmaceuticals, Novartis Venture Fund, QED Therapeutics, and TAVEC outside the submitted work. Ju Dong Yang reports personal fees from Exact Sciences, Gilead Sciences, and Eisai outside the submitted work. The remaining authors made no disclosures.
Publisher Copyright:
© 2022 American Cancer Society.
PY - 2022/10
Y1 - 2022/10
N2 - Background: Curative surgical treatments afford the best prognosis for patients with intrahepatic cholangiocarcinoma (iCCA); however, the comparative effectiveness of treatment options and factors associated with curative treatment receipt for early stage iCCA remain unknown. Methods: The authors identified patients who were diagnosed with early stage iCCA, defined as a unifocal tumor <3 cm, during 2004–2018 from the National Cancer Database. Multivariable logistic and Cox regression analyses were used to identify the factors associated with curative treatment and overall survival (OS), respectively. Results: The proportion of patients with early stage iCCA increased from 4.5% in 2004 to 7.3% in 2018, with the odds of early stage detection increasing by 3.1% per year (odds ratio [OR], 1.031; 95% CI, 1.015–1.049). Of 1093 patients who had early stage iCCA, 464 (42.5%) underwent resection, 113 (10.3%) underwent ablation, 62 (5.7%) underwent liver transplantation, and 454 (41.5%) received noncurative treatments. Hispanic patients (adjusted OR [aOR], 0.57; 95% CI, 0.33–0.97) and Black patients (aOR, 0.47; 95% CI, 0.28–0.77) were less likely to receive curative treatments than White patients. Compared with patients who underwent surgical resection, those who underwent liver transplantation had a trend toward improved OS (adjusted hazard ratio [aHR], 0.63; 95% CI, 0.37–1.08), whereas those who underwent local ablation (aHR, 1.39; 95% CI, 1.01–1.92) and noncurative treatments (aHR, 3.97; 95% CI, 3.24–4.88) experienced worse OS. Conclusions: More than one third of patients with early stage iCCA did not receive curative treatment, with Hispanic and Black patients being less likely to receive curative treatments than White patients. Surgical resection and liver transplantation were associated with improved survival compared with local ablation. Future studies should investigate disparities in curative treatment receipt and outcomes for early stage iCCA.
AB - Background: Curative surgical treatments afford the best prognosis for patients with intrahepatic cholangiocarcinoma (iCCA); however, the comparative effectiveness of treatment options and factors associated with curative treatment receipt for early stage iCCA remain unknown. Methods: The authors identified patients who were diagnosed with early stage iCCA, defined as a unifocal tumor <3 cm, during 2004–2018 from the National Cancer Database. Multivariable logistic and Cox regression analyses were used to identify the factors associated with curative treatment and overall survival (OS), respectively. Results: The proportion of patients with early stage iCCA increased from 4.5% in 2004 to 7.3% in 2018, with the odds of early stage detection increasing by 3.1% per year (odds ratio [OR], 1.031; 95% CI, 1.015–1.049). Of 1093 patients who had early stage iCCA, 464 (42.5%) underwent resection, 113 (10.3%) underwent ablation, 62 (5.7%) underwent liver transplantation, and 454 (41.5%) received noncurative treatments. Hispanic patients (adjusted OR [aOR], 0.57; 95% CI, 0.33–0.97) and Black patients (aOR, 0.47; 95% CI, 0.28–0.77) were less likely to receive curative treatments than White patients. Compared with patients who underwent surgical resection, those who underwent liver transplantation had a trend toward improved OS (adjusted hazard ratio [aHR], 0.63; 95% CI, 0.37–1.08), whereas those who underwent local ablation (aHR, 1.39; 95% CI, 1.01–1.92) and noncurative treatments (aHR, 3.97; 95% CI, 3.24–4.88) experienced worse OS. Conclusions: More than one third of patients with early stage iCCA did not receive curative treatment, with Hispanic and Black patients being less likely to receive curative treatments than White patients. Surgical resection and liver transplantation were associated with improved survival compared with local ablation. Future studies should investigate disparities in curative treatment receipt and outcomes for early stage iCCA.
KW - comparative effectiveness research
KW - curative treatment
KW - epidemiology
KW - intrahepatic cholangiocarcinoma
KW - liver cancer
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U2 - 10.1002/cncr.34436
DO - 10.1002/cncr.34436
M3 - Article
C2 - 35997126
AN - SCOPUS:85136456234
SN - 0008-543X
VL - 128
SP - 3610
EP - 3619
JO - Cancer
JF - Cancer
IS - 20
ER -