Characteristics and trends in treatment utilization in young-onset cholangiocarcinoma.

Abstract

386 Background: Although the incidence of cholangiocarcinoma is rising, little is known about the demographic and clinical characteristics of patients with young-onset cholangiocarcinoma (YOCC), diagnosed at age < 50 years. The objective of this study was to compare patients with YOCC, and patients with typical-onset cholangiocarcinoma (TOCC; diagnosed age >50 years), and to describe trends in treatment utilization and factors associated with survival in YOCC. Methods: We identified patients diagnosed with intrahepatic cholangiocarcinoma, extrahepatic cholangiocarcinoma, and hilar cholangiocarcinoma from the National Cancer Database (NCDB) between 2004 and 2016. Patients were classified as either having YOCC or TOCC. Categorical variables were compared using the chi-square test with Bonferroni correction. Multivariate survival analyses were performed using the Cox-regression model after adjusting for age, gender, race/ethnicity, comorbidity index, insurance status, laterality, definitive surgery, radiotherapy, and chemotherapy. Results: We identified 26,346 patients, of which 2,520 had YOCC (9.6%, median age 44 years) and 23,826 had TOCC (90.4%, median age 68 years). Patients with YOCC were more likely to be non-White (YOCC 35.0% vs. TOCC 27.4%, p <0.01) and had lower overall comorbidity burden. Patients with YOCC were more likely to present with stage IV disease (YOCC 50.5% vs. TOCC 43.5%, p <0.001) and have intrahepatic cholangiocarcinoma (YOCC 56.0% vs. TOCC 45.5%, p<0.001). Patients with YOCC were more likely to receive definitive surgery (YOCC 30.9% vs. TOCC 25.0%, p <0.001) radiation (YOCC 27.7% vs. TOCC 19.0%, p<0.001), and chemotherapy (YOCC 73.1% vs. TOCC 50.4%, p<0.001). In adjusted analyses, patients with YOCC had a 21% decreased risk of death compared to patients with TOCC [HR 0.79 (95% CI 0.75-0.83), p<0.001)]. This remained true for subgroups of patients with intrahepatic disease and those who underwent definitive surgery. Conclusions: YOCC constitutes a small but distinct subgroup of cholangiocarcinoma. Patients with YOCC were more likely to be non-White and present with intrahepatic cholangiocarcinoma disease. Despite being more likely to be diagnosed with advanced stage cholangiocarcinoma, patients with YOCC had better overall survival.