Survival analysis and prognostication of cholangiocarcinoma: A SEER database study.

Abstract

e16208 Background: Cholangiocarcinoma, a rare but highly lethal malignancy arising from the bile duct epithelium, presents a significant clinical challenge due to its typically advanced stage at diagnosis. This rare cancer has known genetic predispositions like Lynch syndrome and multiple biliary papillomatosis. Adenocarcinoma is the most prevalent histological subtype, comprising over 90% of cases, with squamous cell carcinoma constituting most of the remaining cases. Methods: We extracted cases of cholangiocarcinoma, using the ICD Code 8160/3, from the SEER database Research Plus Data, 17 Registries, Nov 2023 Sub (2000-2021). The data were stratified based on age, sex, race, laterality, primary site labeled, stage, median household income adjusted for inflation, treatment adjusted to 2022, and treatment modalities used. Survival curves were compared using the Log-Rank test (GraphPad Prism). Results: There were 30,403 cholangiocarcinoma cases found, with men accounting for 51.2% of the cases. For males, the median survival (MoS) was 6 months, while for females, it was 7 months (p < 0.0007). According to the age, 74.7% of cases occurred in the 60+ age group (MoS: 5 months), 24.9% occurred in the 31-60 age group (MoS: 10 months), and 0.4% occurred in the 0-30 age group (MoS: 14 months) (p < 0.0001). White people comprised 62.1%, Hispanics 16.4%, Asians and Pacific Islanders 12.5%, Black people 7.9%, American Indians and Alaska Natives 0.9%. The highest MoS was 7 months for Asians and Pacific Islanders, 6 months for Whites and Hispanics, 5 months for Blacks, and 4 months for American Indians and Alaska Natives (p < 0.0001). Disease stage heavily influenced survival, with localized cases (19.4%) having an MoS of 15 months, regional cases (23.9%) at 10 months, distant cases (35.6%) at 4 months, and unknown stage cases (21.1%) at 3 months. Patients without regional lymph node involvement had a significantly higher MoS (35 months vs 5 months with regional lymph nodes). Treatment factors showed that 22.2% underwent surgery (MoS: 26 months vs. 4 months for no surgery), 43.4% received chemotherapy (MoS: 12 months vs. 3 months without chemo), and 13.2% had radiation therapy (MoS: 15 months vs. 5 months without radiation). Those earning > $100K have a better MoS of 8 months vs 6 months for people earning < $100K. All findings for disease stage, Lymph node, treatments, and income were statistically significant (p < 0.0001). Conclusions: Surgery, chemotherapy, or radiation therapy were associated with significantly better MoS. This disease favors Asian and Pacific Islanders and the younger age group. It is more prevalent in older age and among whites but with poorer outcomes. Advanced disease stages were associated with poorer survival outcomes. Despite being rare in the US, its poor prognosis highlights the need for early detection, aggressive treatment strategies, and further research to identify novel therapies for this challenging cancer.