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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

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

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