A SEER-based multi-ethnic picture of advanced intrahepatic cholangiocarcinoma in the United States pre- and post-the advent of gemcitabine/cisplatin

Background: Cholangiocarcinoma (CCA) is a rare, lethal cancer with 5-year survival of less than 10%. Although incidence rates have been increasing in the United States, ethnic variations in survival have not been investigated. We examined multi-ethnic variation in overall survival (OS) and CCA-specific survival (CSS) using data from the population-based Surveillance Epidemiology and End Results (SEER) program in the 4-year period after introduction of gemcitabine/cisplatin (GC) as treatment for CCA, compared with prior years. Methods: The study included data from 5,616 advanced, intrahepatic CCA cases reported in SEER between 1990 and 2013. Multivariable-adjusted hazard ratios (HR) and 95% confidence intervals (CIs) were calculated to examine OS and CSS by ethnicity, age, gender and in the pre- and post-GC era (1990–2000, 2001–2009 vs. 2010–2013). Results: Compared to non-Hispanic Whites, Hispanics had poorer 3-year OS (HR 1.11, 95% CI: 1.03–1.20) and 3-year CSS (HR 1.15, 95% CI: 1.05–1.25). Similarly, non-Hispanic Blacks had 3-year OS (HR 1.21, 95% CI: 1.10–1.34) and 3-year CSS (HR 1.21, 95% CI: 1.09–1.35). Males and older patients had shorter survival compared to females and younger patients. OS and CSS were both improved for patients’ post-advent of GC. Statistically significant improvement in CSS pre- and post-advent of GC was noted in non-Hispanic Whites, while Hispanics actually had worsened survival. Conclusions: Hispanics and non-Hispanic Blacks have worse survival after diagnosis with advanced, intrahepatic CCA. Further studies are needed to determine determinants of poor survival among these groups.