Comparison of Clinical Features and Outcomes Between... : Hepatology (original) (raw)

Original Articles: Hepatobiliary Malignancies

Comparison of Clinical Features and Outcomes Between Intrahepatic Cholangiocarcinoma and Hepatocellular Carcinoma in the United States

Lee, Yi‐Te1,2; Wang, Jasmine J.2,3; Luu, Michael4; Noureddin, Mazen5,6; Nissen, Nicholas N.3,6; Patel, Tushar C.7; Roberts, Lewis R.8; Singal, Amit G.9; Gores, Gregory J.8; Yang, Ju Dong*,3,5,6

1California NanoSystems InstituteCrump Institute for Molecular ImagingUniversity of California–Los AngelesLos AngelesCA

2Department of Molecular and Medical PharmacologyUniversity of California–Los AngelesLos AngelesCA

3Samuel Oschin Comprehensive Cancer InstituteCedars‐Sinai Medical CenterLos AngelesCA

4Biostatistics and Bioinformatics Research CenterCedars‐Sinai Medical CenterLos AngelesCA

5Karsh Division of Gastroenterology and HepatologyCedars‐Sinai Medical CenterLos AngelesCA

6Comprehensive Transplant CenterCedars‐Sinai Medical CenterLos AngelesCA

7Division of Gastroenterology and HepatologyMayo ClinicJacksonvilleFL

8Division of Gastroenterology and HepatologyMayo ClinicRochesterMN

9Division of Digestive and Liver DiseasesUniversity of Texas Southwestern Medical CenterDallasTX

* ADDRESS CORRESPONDENCE AND REPRINT REQUESTS TO:
Ju Dong Yang, M.D., M.S.
Karsh Division of Gastroenterology and Hepatology, Samuel Oschin Comprehensive Cancer Institute, Comprehensive Transplant Center, Cedars‐Sinai Medical Center
8900 Beverly Boulevard
Los Angeles, CA 90048
E‐mail: [email protected]
Tel.: +1‐310‐423‐1971

Abstract

Background and Aims

Intrahepatic cholangiocarcinoma (iCCA) and hepatocellular carcinoma (HCC) are the most common primary liver cancers (PLCs). Differences in their clinical features and outcomes are open for investigation in a large‐scale study. We aim to investigate the differences in clinical features and outcomes between iCCA and HCC.

Approach and Results

The Surveillance, Epidemiology, and End Results Program 18 Database (2000‐2017) was used to extract demographic and clinical features of HCC and iCCA patients. Logistic regression analysis was performed to identify factors associated with iCCA diagnosis versus HCC. Cox regression analysis was used to assess factors affecting overall survival (OS). There were 13,611 iCCA and 96,151 HCC patients. Half of iCCA (50.7%) and three quarters of HCC (76.3%) patients were male. Diagnosis in recent year, age (<50 or ≥65), female sex, non‐Hispanic White race, higher income, rural area, and higher tumor burden were independently associated with iCCA diagnosis versus HCC. Patients with iCCA had worse OS than those with HCC (9 vs. 13 months; P < 0.001). However, OS was comparable between iCCA and HCC in multivariable analysis (adjusted hazard ratio [aHR] = 1.02; 95% CI = 0.99‐1.05). In subgroup analyses, iCCA was associated with better OS than HCC in patients with tumor ≥5 cm (aHR = 0.83; 95% CI = 0.80‐0.86), lymph node involvement (aHR = 0.76; 95% CI = 0.72‐0.81), distant metastasis (aHR = 0.76; 95% CI = 0.73‐0.79), poorly/undifferentiated tumors (aHR = 0.88; 95% CI = 0.83‐0.94), and those receiving noncurative treatment (aHR = 0.96; 95% CI = 0.93‐0.98).

Conclusions

We identified the demographic, socioeconomic, and clinical features associated with iCCA diagnosis over HCC among patients with PLC. Although iCCA patients presented at an advanced stage, OS was similar between iCCA and HCC in multivariable analysis. iCCA was associated with longer OS for subgroups with poor prognostic features.