Annals of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회지)

The Korean Association of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회)
권호 표지
DOI QR코드

DOI QR Code

Associations between income and survival in cholangiocarcinoma: A comprehensive subtype-based analysis

  • Calvin X. Geng (Department of Medicine, University of Virginia) ;
  • Anuragh R. Gudur (Department of Medicine, University of Virginia) ;
  • Jagannath Kadiyala (Department of Medicine, University of Virginia) ;
  • Daniel S. Strand (Division of Gastroenterology and Hepatology, Department of Medicine, University of Virginia) ;
  • Vanessa M. Shami (Division of Gastroenterology and Hepatology, Department of Medicine, University of Virginia) ;
  • Andrew Y. Wang (Division of Gastroenterology and Hepatology, Department of Medicine, University of Virginia) ;
  • Alexander Podboy (Division of Gastroenterology and Hepatology, Department of Medicine, University of Virginia) ;
  • Tri M. Le (Division of Hematology and Oncology, Department of Medicine, University of Virginia) ;
  • Matthew Reilley (Division of Hematology and Oncology, Department of Medicine, University of Virginia) ;
  • Victor Zaydfudim (Division of Surgical Oncology, Department of Surgery, University of Virginia) ;
  • Ross C. D. Buerlein (Division of Gastroenterology and Hepatology, Department of Medicine, University of Virginia)
  • Received : 2023.10.31
  • Accepted : 2024.01.14
  • Published : 2024.05.31
Download PDF
⟨ Previous Next ⟩

Abstract

Backgrounds/Aims: Socioeconomic determinants of health are incompletely characterized in cholangiocarcinoma (CCA). We assessed how socioeconomic status influences initial treatment decisions and survival outcomes in patients with CCA, additionally performing multiple sub-analyses based on anatomic location of the primary tumor. Methods: Observational study using the 2018 submission of the Surveillance, Epidemiology, and End Results (SEER)-18 Database. In total, 5,476 patients from 2004-2015 with a CCA were separated based on median household income (MHI) into low income (< 25th percentile of MHI) and high income (> 25th percentile of MHI) groups. Seventy-three percent of patients had complete follow up data, and were included in survival analyses. Survival and treatment outcomes were calculated using R-studio. Results: When all cases of CCA were included, the high-income group was more likely than the low-income to receive surgery, chemotherapy, and local tumor destruction modalities. Initial treatment modality based on income differed significantly between tumor locations. Patients of lower income had higher overall and cancer-specific mortality at 2 and 5 years. Non-cancer mortality was similar between the groups. Survival differences identified in the overall cohort were maintained in the intrahepatic CCA subgroup. No differences between income groups were noted in cancer-specific or overall mortality for perihilar tumors, with variable differences in the distal cohort. Conclusions: Lower income was associated with higher rates of cancer-specific mortality and lower rates of surgical resection in CCA. There were significant differences in treatment selection and outcomes between intrahepatic, perihilar, and distal tumors. Population-based strategies aimed at identifying possible etiologies for these disparities are paramount to improving patient outcomes.

Keywords

References

  1. Gad MM, Saad AM, Faisaluddin M, Gaman MA, Ruhban IA, Jazieh KA, et al. Epidemiology of cholangiocarcinoma; United States incidence and mortality trends. Clin Res Hepatol Gastroenterol 2020;44:885-893. https://doi.org/10.1016/j.clinre.2020.03.024
  2. Patel N, Benipal B. Incidence of cholangiocarcinoma in the USA from 2001 to 2015: a US cancer statistics analysis of 50 states. Cureus 2019;11:e3962.
  3. Rizvi S, Gores GJ. Pathogenesis, diagnosis, and management of cholangiocarcinoma. Gastroenterology 2013;145:1215-1229. https://doi.org/10.1053/j.gastro.2013.10.013
  4. Cillo U, Fondevila C, Donadon M, Gringeri E, Mocchegiani F, Schlitt HJ, et al. Surgery for cholangiocarcinoma. Liver Int 2019;39 Suppl 1:143-155. https://doi.org/10.1111/liv.14089
  5. Brindley PJ, Bachini M, Ilyas SI, Khan SA, Loukas A, Sirica AE, et al. Cholangiocarcinoma. Nat Rev Dis Primers 2021;7:65.
  6. Uppal DS, Wang AY. Advances in endoscopic retrograde cholangiopancreatography for the treatment of cholangiocarcinoma. World J Gastrointest Endosc 2015;7:675-687. https://doi.org/10.4253/wjge.v7.i7.675
  7. Singh GK, Jemal A. Socioeconomic and racial/ethnic disparities in cancer mortality, incidence, and survival in the United States, 1950- 2014: over six decades of changing patterns and widening inequalities. J Environ Public Health 2017;2017:2819372.
  8. Geng CX, Gudur AR, Radlinski M, Buerlein RCD, Strand DS, Sauer BG, et al. Socioeconomic disparities affect outcomes in early-stage esophageal adenocarcinoma: a SEER analysis. Clin Gastroenterol Hepatol 2023;21:2797-2806.e6. https://doi.org/10.1016/j.cgh.2023.02.011
  9. Zhu MX, Li Y. The correlations between socioeconomic status and intrahepatic cholangiocarcinoma in the United States: a population- based study. Transl Cancer Res 2020;9:4931-4942. https://doi.org/10.21037/tcr-20-2506
  10. National Cancer Institute. Static county attributes [Internet]. NIH 2022 [cited 2022 Jul 11]. Available from: https://seer.cancer.gov/seerstat/variables/countyattribs/static.html-:~:text=The%20static%20county%20attributes%20are,populations%20from%20survey%20sample%20data.
  11. Woods LM, Rachet B, Coleman MP. Origins of socio-economic inequalities in cancer survival: a review. Ann Oncol 2006;17:5-19. https://doi.org/10.1093/annonc/mdj007
  12. Wrigley H, Roderick P, George S, Smith J, Mullee M, Goddard J. Inequalities in survival from colorectal cancer: a comparison of the impact of deprivation, treatment, and host factors on observed and cause specific survival. J Epidemiol Community Health 2003;57:301-309. https://doi.org/10.1136/jech.57.4.301
  13. Thomson CS, Hole DJ, Twelves CJ, Brewster DH, Black RJ; Scottish Cancer Therapy Network. Prognostic factors in women with breast cancer: distribution by socioeconomic status and effect on differences in survival. J Epidemiol Community Health 2001;55:308-315. https://doi.org/10.1136/jech.55.5.308
  14. Zullig LL, Jackson GL, Provenzale D, Griffin JM, Phelan S, van Ryn M. Transportation: a vehicle or roadblock to cancer care for VA patients with colorectal cancer? Clin Colorectal Cancer 2012;11:60-65. https://doi.org/10.1016/j.clcc.2011.05.001
  15. Lee RM, Liu Y, Gamboa AC, Zaidi MY, Kooby DA, Shah MM, et al. Race, ethnicity, and socioeconomic factors in cholangiocarcinoma: what is driving disparities in receipt of treatment? J Surg Oncol 2019;120:611-623. https://doi.org/10.1002/jso.25632
  16. Welzel TM, McGlynn KA, Hsing AW, O'Brien TR, Pfeiffer RM. Impact of classification of hilar cholangiocarcinomas (Klatskin tumors) on the incidence of intra- and extrahepatic cholangiocarcinoma in the United States. J Natl Cancer Inst 2006;98:873-875. https://doi.org/10.1093/jnci/djj234
  17. Walter D, Ferstl P, Waidmann O, Trojan J, Hartmann S, Schnitzbauer AA, et al. Cholangiocarcinoma in Germany: epidemiologic trends and impact of misclassification. Liver Int 2019;39:316-323. https://doi.org/10.1111/liv.13954
  18. Khan SA, Emadossadaty S, Ladep NG, homas HC, Elliott P, Taylor-Robinson SD, et al. Rising trends in cholangiocarcinoma: is the ICD classification system misleading us? J Hepatol 2012;56:848-854. https://doi.org/10.1016/j.jhep.2011.11.015
  19. Khan SA, Tavolari S, Brandi G. Cholangiocarcinoma: epidemiology and risk factors. Liver Int 2019;39 Suppl 1:19-31. https://doi.org/10.1111/liv.14095