Association between treatment facility volume, therapy types and overall survival in patients with intrahepatic cholangiocarcinoma

Anuhya Kommalapati, Sri Harsha Tella, Gaurav Goyal, Mitesh J Borad, Steven Robert Alberts, Lewis Rowland Roberts, Joleen M Hubbard, Lori Durgin, Sean Cleary, Amit Mahipal

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Abstract

Background: To determine the association between the number of patients with intra-hepatic cholangiocarcinoma (IHCC) treated annually at a treatment facility (volume) and overall survival (outcome). Methods: Patients with IHCC reported to the National Cancer Database (years 2004–2015) were included. We classified facilities by tertiles (T; mean IHCC patients treated/year): T1: <2.56; T2: 2.57–5.39 and T3: ≥5.40. Volume–outcome relationship was determined by using Cox regression adjusting for patient demographics, comorbidities, tumor characteristics, insurance type and therapy received. Results: There were 11,344 IHCC patients treated at 1106 facilities. On multivariable analysis, facility volume was independently associated with all-cause mortality (p < 0.001). The unadjusted median OS by facility volume was: T1: 5 months (m), T2: 8.1 m, and T3: 13.1 m (p < 0.001). Compared with patients treated at T3 facilities, patients treated at lower-tertile facilities had significantly higher risk of death [T2 hazard ratio (HR), 1.12 [95% CI, 1.05–1.23]; T1 HR, 1.21 [95% CI, 1.11–1.33]. Patients treated at high-volume centers were more likely to get surgery (34.6 vs 13.1%) and adjuvant therapy. Conclusion: IHCC patients treated at high-volume facilities had a significant improvement in OS and were more likely to receive surgery and adjuvant therapy as compared to that of patients at low-volume facilities.

Original languageEnglish (US)
JournalHPB
DOIs
StateAccepted/In press - Jan 1 2018

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Cholangiocarcinoma
Survival
Liver
Therapeutics
Insurance
Comorbidity
Neoplasms
Demography
Databases

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

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title = "Association between treatment facility volume, therapy types and overall survival in patients with intrahepatic cholangiocarcinoma",
abstract = "Background: To determine the association between the number of patients with intra-hepatic cholangiocarcinoma (IHCC) treated annually at a treatment facility (volume) and overall survival (outcome). Methods: Patients with IHCC reported to the National Cancer Database (years 2004–2015) were included. We classified facilities by tertiles (T; mean IHCC patients treated/year): T1: <2.56; T2: 2.57–5.39 and T3: ≥5.40. Volume–outcome relationship was determined by using Cox regression adjusting for patient demographics, comorbidities, tumor characteristics, insurance type and therapy received. Results: There were 11,344 IHCC patients treated at 1106 facilities. On multivariable analysis, facility volume was independently associated with all-cause mortality (p < 0.001). The unadjusted median OS by facility volume was: T1: 5 months (m), T2: 8.1 m, and T3: 13.1 m (p < 0.001). Compared with patients treated at T3 facilities, patients treated at lower-tertile facilities had significantly higher risk of death [T2 hazard ratio (HR), 1.12 [95{\%} CI, 1.05–1.23]; T1 HR, 1.21 [95{\%} CI, 1.11–1.33]. Patients treated at high-volume centers were more likely to get surgery (34.6 vs 13.1{\%}) and adjuvant therapy. Conclusion: IHCC patients treated at high-volume facilities had a significant improvement in OS and were more likely to receive surgery and adjuvant therapy as compared to that of patients at low-volume facilities.",
author = "Anuhya Kommalapati and Tella, {Sri Harsha} and Gaurav Goyal and Borad, {Mitesh J} and Alberts, {Steven Robert} and Roberts, {Lewis Rowland} and Hubbard, {Joleen M} and Lori Durgin and Sean Cleary and Amit Mahipal",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.hpb.2018.08.004",
language = "English (US)",
journal = "HPB",
issn = "1365-182X",
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T1 - Association between treatment facility volume, therapy types and overall survival in patients with intrahepatic cholangiocarcinoma

AU - Kommalapati, Anuhya

AU - Tella, Sri Harsha

AU - Goyal, Gaurav

AU - Borad, Mitesh J

AU - Alberts, Steven Robert

AU - Roberts, Lewis Rowland

AU - Hubbard, Joleen M

AU - Durgin, Lori

AU - Cleary, Sean

AU - Mahipal, Amit

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: To determine the association between the number of patients with intra-hepatic cholangiocarcinoma (IHCC) treated annually at a treatment facility (volume) and overall survival (outcome). Methods: Patients with IHCC reported to the National Cancer Database (years 2004–2015) were included. We classified facilities by tertiles (T; mean IHCC patients treated/year): T1: <2.56; T2: 2.57–5.39 and T3: ≥5.40. Volume–outcome relationship was determined by using Cox regression adjusting for patient demographics, comorbidities, tumor characteristics, insurance type and therapy received. Results: There were 11,344 IHCC patients treated at 1106 facilities. On multivariable analysis, facility volume was independently associated with all-cause mortality (p < 0.001). The unadjusted median OS by facility volume was: T1: 5 months (m), T2: 8.1 m, and T3: 13.1 m (p < 0.001). Compared with patients treated at T3 facilities, patients treated at lower-tertile facilities had significantly higher risk of death [T2 hazard ratio (HR), 1.12 [95% CI, 1.05–1.23]; T1 HR, 1.21 [95% CI, 1.11–1.33]. Patients treated at high-volume centers were more likely to get surgery (34.6 vs 13.1%) and adjuvant therapy. Conclusion: IHCC patients treated at high-volume facilities had a significant improvement in OS and were more likely to receive surgery and adjuvant therapy as compared to that of patients at low-volume facilities.

AB - Background: To determine the association between the number of patients with intra-hepatic cholangiocarcinoma (IHCC) treated annually at a treatment facility (volume) and overall survival (outcome). Methods: Patients with IHCC reported to the National Cancer Database (years 2004–2015) were included. We classified facilities by tertiles (T; mean IHCC patients treated/year): T1: <2.56; T2: 2.57–5.39 and T3: ≥5.40. Volume–outcome relationship was determined by using Cox regression adjusting for patient demographics, comorbidities, tumor characteristics, insurance type and therapy received. Results: There were 11,344 IHCC patients treated at 1106 facilities. On multivariable analysis, facility volume was independently associated with all-cause mortality (p < 0.001). The unadjusted median OS by facility volume was: T1: 5 months (m), T2: 8.1 m, and T3: 13.1 m (p < 0.001). Compared with patients treated at T3 facilities, patients treated at lower-tertile facilities had significantly higher risk of death [T2 hazard ratio (HR), 1.12 [95% CI, 1.05–1.23]; T1 HR, 1.21 [95% CI, 1.11–1.33]. Patients treated at high-volume centers were more likely to get surgery (34.6 vs 13.1%) and adjuvant therapy. Conclusion: IHCC patients treated at high-volume facilities had a significant improvement in OS and were more likely to receive surgery and adjuvant therapy as compared to that of patients at low-volume facilities.

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SN - 1365-182X

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