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



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.


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.


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

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Supplementary material 1 (DOCX 5328 kb)


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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

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