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Trends in the Incidence, Treatment and Outcomes of Patients with Intrahepatic Cholangiocarcinoma in the USA: Facility Type is Associated with Margin Status, Use of Lymphadenectomy and Overall Survival

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Abstract

Introduction

Intrahepatic cholangiocarcinoma (ICC) remains an uncommon disease with a rising incidence worldwide. We sought to identify trends in therapeutic approaches and differences in patient outcomes based on facility types.

Methods

Between January 1, 2004, and December 31, 2015, a total of 27,120 patients with histologic diagnosis of ICC were identified in the National Cancer Database and were enrolled in this study.

Results

The incidence of ICC patients increased from 1194 in 2004 to 3821 in 2015 with an average annual increase of 4.16% (p < 0.001). Median survival of the cohort improved over the last 6 years of the study period (2004–2009: 8.05 months vs. 2010–2015: 9.49 months; p < 0.001). Among surgical patients (n = 5943, 21.9%), the incidence of R0 resection, lymphadenectomy and harvest of ≥6 lymph nodes increased over time (p < 0.001). Positive surgical margins (referent R0: R1, HR 1.49, 95% CI 1.24–1.79, p < 0.001) and treatment at community cancer centers (referent academic centers; HR 1.24, 95% CI 1.04–1.49, p = 0.023) were associated with a worse prognosis. Patients treated at academic centers had higher rates of R0 resection (72.4% vs. 67.7%; p = 0.006) and lymphadenectomy (55.6% vs. 49.5%, p = 0.009) versus community cancer centers. Overall survival was also better at academic versus community cancer programs (median OS: 11 months versus 6 months, respectively; p < 0.001).

Conclusions

The incidence of ICC has increased over the last 12 years in the USA with a moderate improvement in survival over time. Treatment at academic cancer centers was associated with higher R0 resection and lymphadenectomy rates, as well as improved OS for patients with ICC.

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Authors and Affiliations

  1. Department of Surgery, Division of Surgical Oncology, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, Professor of Surgery, Oncology, Health Services Management and Policy, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, 395 W. 12th Ave., Suite 670, Columbus, OH, USA

    Lu Wu, Diamantis I. Tsilimigras, Anghela Z. Paredes, Rittal Mehta, J. Madison Hyer, Katiuscha Merath, Kota Sahara, Fabio Bagante, Eliza W. Beal & Timothy M. Pawlik

  2. Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China

    Lu Wu & Feng Shen

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  1. Lu Wu
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Correspondence to Timothy M. Pawlik.

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Lu Wu and Diamantis I. Tsilimigras contributed equally to this work.

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Supplementary material 1 (DOCX 16 kb)

Supplemental Figure 1

Trends in the use of chemotherapy and radiotherapy among patients with ICC who received non-surgical treatment (TIFF 77 kb)

Supplemental Figure 2

Trends in the use of chemotherapy (a) and radiotherapy (b) among non-surgical patients treated at different facility settings (TIFF 1075 kb)

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Wu, L., Tsilimigras, D.I., Paredes, A.Z. et al. Trends in the Incidence, Treatment and Outcomes of Patients with Intrahepatic Cholangiocarcinoma in the USA: Facility Type is Associated with Margin Status, Use of Lymphadenectomy and Overall Survival. World J Surg 43, 1777–1787 (2019). https://doi.org/10.1007/s00268-019-04966-4

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  • DOI: https://doi.org/10.1007/s00268-019-04966-4

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