Cholangiocarcinoma: A nationwide trend analysis from 2016 to 2020.

Abstract

e16177 Background: Cholangiocarcinomas (CCAs) are epithelial malignancies arising from the biliary ductal system, occurring with an incidence of 1/100,000 people per year in the US. Most patients present with advanced-stage disease and prognosis is very poor, with five-year mortality rates ranging from 2-24% depending on stage and subtype. This study was designed to determine the trends and adverse outcomes of CCA. Methods: This retrospective trend study analyzes data from the Nationwide Inpatient Sample (NIS) for the years 2016-2020 to identify adult hospitalizations with a diagnosis of cholangiocarcinoma and to highlight epidemiological trends. Inpatient mortality, mean length of stay (LOS), mean total hospital charge (THC), and rates of procedures and complications were estimated. Multivariate regression trend analysis was used to assess statistical significance and adjust for confounders. Results: There was an increase in the number of CCA hospitalizations per total hospitalizations from 8.49/100,000 in 2016 to 11.0/100,000 in 2020 (p < 0.01). Mean age remained around 67 years old, and male predominance remained constant throughout this period (52.7%). White patients made up the majority of the study population (65.6%). Inpatient mortality ranged from 6.8% to 7.1%, with no statistically significant trend. However, there was an increase in mean THC (P-trend <0.05) with no significant change in mean LOS (P-trend 0.76). We found a decrease in endoscopic retrograde cholangiopancreatographies (ERCPs) performed (1.6% to 1.2%, p=0.05), biliary duct stents placed (1.2% to 0.6%, p=0.003), and percutaneous biliary tract drains placed (4.2% to 3.4%, p=0.002) from 2016 to 2020. An increase was seen in rates of acute kidney injury (AKI) (22.9% to 28.6%, P<0.05), stent-related complications (2.0% to 2.6%, P=0.01), and peritoneal metastasis (7.7% to 9.3%, P<0.05). Biliary duct obstruction, stent-related infection, and palliative care utilization did not show any statistically significant change during this time. Conclusions: CCA hospitalizations increased from 2016 to 2020. Demographics remained unchanged, with a stable inpatient mortality rate but increased THC. The use of ERCPs, biliary duct stents, and percutaneous biliary tract drainage devices decreased, but rates of AKI, stent-related complications, and peritoneal metastasis increased. It is unclear what factors led to decreased procedure rates and increased complication rates. No significant changes were observed in biliary duct obstruction, stent-related infections, or palliative care utilization.[Table: see text]