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Intrahepatic Cholangiocarcinoma: Surgical Intervention has not Improved Survival in the Elderly
*George Cholankeril, Ali Ahmad, Ponnandai Somasundar
Roger Williams Medical Center, Providence, RI
Objective: Intrahepatic cholangiocarcinoma (ICC) is the second most common primary hepatic malignancy. It is associated with a poor survival and limited therapeutic options. We investigated overall median survival (MS) in patients with ICC with cancer directed surgery (CDS).
Design:Retrospective review of Surveillance, Epidemiology and End Results (SEER) database ICC CDS patients. CDS patients were subdivided based on gender, (localized, regional and distant metastases) and age group (55-65, 65-75 and 75+).
Setting: Academic Medical Centers
Patients: Diagnosed ICC patients with CDS
Interventions: None
Main Outcome Measure: Overall Median Survival in patients with ICC CDS.
Results:Using the SEER database, we identified all patients with ICC CDS between 1990 and 2011 (n = 6204), which were subdivided into two cohorts; 1990-2000 (n=1841) and 2001-2011(n=4361). In the 55-65 age population, MS significantly improved from 1990-2011 in localized, regional and distant metastases with CDS. In the 65-75 age population MS improved only in CDS localized disease; 7 months (1990-2000) to 9.8 months (2001-2011). In the 75+ age population, the MS from 1990-2000 and 2001-2011 did not show significant change regardless of extent of disease; localized CDS patients was 6.6 months (1990-2000) compared to 6 months (2001-2011).
Conclusion: Over the last two decades, there has been an increased incidence in patients receiving CDS likely due to advancements in hepatic resection. The overall survival in the elderly population with CDS (75+) though remains poor throughout the last two decades regardless of the extent of the disease. Advanced age seems to be a poor prognostic factor even with CDS, suggesting future study in this age population.
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