Associations between income and survival in cholangiocarcinoma:A comprehensive subtype-based analysis
- Author:
Calvin X. GENG
1
;
Anuragh R. GUDUR
;
Jagannath KADIYALA
;
Daniel S. STRAND
;
Vanessa M. SHAMI
;
Andrew Y. WANG
;
Alexander PODBOY
;
Tri M. LE
;
Matthew REILLEY
;
Victor ZAYDFUDIM
;
Ross C. D. BUERLEIN
Author Information
- Publication Type:Original Article
- From: Annals of Hepato-Biliary-Pancreatic Surgery 2024;28(2):144-154
- CountryRepublic of Korea
- Language:English
-
Abstract:
Background:s/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.
