High Mortality Rates Despite Younger Age Among Patients With Intrahepatic Cholangiocarcinoma & Primary Sclerosing Cholangitis

Document Type

Conference Proceeding

Publication Date

10-25-2023

Publication Title

Am J Gastroenterol

Abstract

Introduction: Intrahepatic cholangiocarcinoma (iCCA) is an aggressive malignancy of the intrahepatic bile ducts and is associated with poor 5-year survival rates. Patients with primary sclerosing cholangitis (PSC) are at an increased risk of developing iCCA. Surveillance programs are recommended to aid early iCCA detection. Despite this, overall survival in this population are far from optimal with limited population-based data. The objective of this study is to assess treatment and survival outcomes of patients with iCCA with and without PSC. Methods: The U.S collaborative Network in the TriNetX platform was analyzed from inception to May 2023. All patients with PSC and concurrent iCCA were included. The control group comprised of patients with iCCA without PSC. One to one propensity score matching (PSM) was done based on age, gender, race, ethnicity, body mass index (BMI), nicotine dependence, chronic hepatitis B infection, chronic hepatitis C infection, and cirrhosis. The primary outcome was all-cause mortality at 5 years from diagnosis of iCCA. Secondary outcomes included rates of liver transplantation between the groups. Risk was expressed as adjusted odds ratio (aOR) with 95% confidence intervals (CI). Results: A total of 574 patients were identified in the PSC-iCCA group (mean age 57±15.6 years, 61% males, 80% Caucasians) and 32,708 patients in the control iCCA without PSC group (mean age 65±13.1, 53% males, 69% were Caucasians). The PSC-iCCA patients were younger (P< 0.01), had higher proportion of patients with IBD while chronic hepatitis C was more common in the control group (Table 1). After PSM, 512 patients with PSC-iCCA were matched with 512 patients without PSC. Overall, 5-year mortality was not significant between the PSC cohort vs non-PSC patients (43.3% vs 48.2%; aOR:0.8. 95% CI: 0.64, 1.05) (Figure 1). Few patients overall underwent liver resection overall (non-PSC 3.3% vs 4.6%, P< 0.01). However, a significantly higher number of patients with PSC underwent liver transplantation (17.7% vs 8.4%; aOR:2.3, 95% CI:1.6, 3.4). Conclusion: While patients with concomitant PSC and iCCA are diagnosed at a younger age, the 5-year mortality rates remain extremely high and comparable to patients without PSC. Despite this, surgical intervention, including transplantation, remains limited. These results emphasize the need for improved surveillance and detection techniques, and need for future research in improving the treatment outcomes for iCCA.

Volume

118

Issue

10

First Page

S36

Last Page

S37

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