To evaluate age-associated differences in treatment patterns and overall survival in patients with nonmetastatic intrahepatic cholangiocarcinoma (ICC) diagnosed between 2004 and 2020.
Approach:
Cohort Selection: Patients diagnosed with ICC were identified from the National Cancer Database (NCDB) and stratified into elderly (>65 years) and younger (≤65 years) cohorts.
Treatment Groups: Patients were analyzed based on treatment modalities: surgery only, chemotherapy only, radiotherapy only, chemotherapy plus radiotherapy, surgery plus chemotherapy or radiotherapy, and trimodality therapy.
Statistical Analysis: Kaplan-Meier survival curves were used to estimate overall survival across treatment groups, with pairwise comparisons conducted using a multivariate log-rank test.
Key Findings:
Among 10,342 patients, 5,259 (50.9%) were elderly.
Elderly patients were less likely to receive trimodality therapy (8.8% vs 14.4%) or surgery plus chemotherapy/radiotherapy (33.2% vs 41.5%).
Surgery alone was more common in elderly patients (58.0% vs 44.1%).
Inoperable elderly patients were less likely to receive chemotherapy-based treatment and more likely to receive radiotherapy alone (7.2% vs 2.8%).
Surgical treatment strategies were associated with significantly improved survival compared to nonsurgical approaches.
Interpretation:
Elderly patients with nonmetastatic ICC experienced treatment de-intensification in both surgical and nonsurgical settings, with surgery being strongly associated with survival.
Limitations:
The study is based on retrospective data from the NCDB, which may limit the granularity of clinical, pathologic, and treatment-specific data.
Conclusion:
Elderly patients with ICC are more likely to receive less aggressive treatment, and while surgery is associated with improved survival, the addition of radiation therapy in inoperable cases may enhance short-term outcomes.
