Annals of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회지)

The Korean Association of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회)
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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
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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.

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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.
  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.
  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.
  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.
  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.
  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.
  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.
  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.
  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.
  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.
  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.
  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.
  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.
  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.
  19. Khan SA, Tavolari S, Brandi G. Cholangiocarcinoma: epidemiology and risk factors. Liver Int 2019;39 Suppl 1:19-31.