Many Patients With iCCA Still Do Not Get Curative Treatment

About 4 in 10 patients do not receive curative therapy despite early detection, a new study shows.

Early detection is critical to survival in patients with intrahepatic cholangiocarcinoma (iCCA), but a new study shows more than 40% of patients whose cancers are detected at an early stage did not receive curative treatment.

The report, published in Cancer, shows rates of curative therapy were lower for Hispanic and Black patients than for White patients.

The findings suggest there is considerable work to do to improve iCCA outcomes, even though progress has been made at early detection of the cancer type.

The study investigators said iCCA is the second most common primary liver cancer in the United States, but a lack of surveillance programs means it is typically not discovered until an advanced stage. In another type of cholangiocarcinoma, hepatocellular cholangiocarcinoma (HCC), studies have found that certain demographic and geographic populations are less likely to receive curative-intent treatments. Yet, the authors said it is not known whether those same disparities apply in iCCA. More fundamentally, however, they said it is difficult to know whether such studies are picking up on disparities in treatment decisions or merely reflecting disparities in early detection.

The new study aimed to look at 2 issues: trends in early detection of iCCA and patterns related to curative-intent treatments among those whose cancers are detected at an early stage. To these ends, investigators pulled data from the National Cancer Database, looking for cases of people with early stage iCCA (defined as having unifocal tumors smaller than 3 cm) diagnoses between 2004 and 2018. They then compared those data to treatments and overall survival (OS).

In total, 4.5% of people with iCCA received an early stage diagnosis in 2004, but the number rose to 7.3% by 2018, representing an annual increase in the odds of early detection of 3.1%.

Of the 1093 records showing early stage iCCA diagnosed during the study time frame, 42.5% underwent surgical resection, 10.3% underwent ablation, and 5.7% received a liver transplant. Of those 3 options, the authors said surgical resection and liver transplantation were associated with the best odds of survival.

The investigators said those data are promising in part because iCCA used to be considered a contraindication for liver transplantation. They said the 67.9% 5-year OS probabilities demonstrated in this study suggest transplantation can be an effective option for patients whose cancers were detected early.

Still, they also noted that 41.5% of people whose cancers were detected at an early stage did not receive curative-intent therapy. Strikingly, according to the authors, the data suggest that Hispanic patients and Black patients were significantly less likely than White patients to receive curative therapy (adjusted odds ratio [aOR], 0.57; 95% CI, 0.33-0.97 for Hispanic patients; aOR, 0.47; 95% CI, 0.28-0.77 for Black patients vs Whites).

The authors said several reasons could explain those disparities. They said some communities have historically had misconceptions about surgery and cancer due to such issues as structural racism and a lack of contact and communication with physicians. Financial and logistical barriers can also limit access to care, they noted. However, they said part of the issue appears connected to the hospitals or clinics patients attend.

“We also demonstrated profound racial and ethnic disparities among Black individuals at nonacademic cancer centers,” they said. “The underlying causes of these disparities between different types of facilities are required to be inspected to improve patients’ outcomes.”

Reference

Lee YT, Singal AG, Lauzon M, et al. Disparities in curative treatments and outcomes for early stage intrahepatic cholangiocarcinoma in the United States. Cancer. Published online August 23, 2022. doi:10.1002/cncr.34436