Abstract
BACKGROUND: Intrahepatic cholangiocarcinoma (iCCA), the second most prevalent primary liver tumor, is associated with high mortality rates despite recent advances in treatment. The influence of socioeconomic factors on prognosis in iCCA remains understudied. Economic disparities among individuals under 65 years who are typically ineligible for Medicare, may influence healthcare outcomes. This study examines the effects of race and income in addition to common prognostic variables on the overall survival (OS) in patients with iCCA under 65 years. METHODS: For this retrospective cohort study, data was extracted from the Surveillance, Epidemiology, and End Results (SEER) 22 database which included iCCA patients aged 20-64 years. The Kaplan-Meier analysis was applied to estimate the median survival time. Log rank test, univariate and multivariate Cox proportional hazards models were used to evaluate the association of age, ethnicity, income, and stage with OS. RESULTS: A total of 8,585 iCCA patients were identified: Hispanic: 22%, non-Hispanic White 57%, Black 10%, Asian 10%, Native American 1%; 53% Males; median age was 57 years (range, 20-64 years) and median household income was $77,500 [interquartile range (IQR), $62,500-$92,500]. The estimated median OS (mOS) was 10 months [95% confidence interval (CI): 10-11]. Cancer stage was highly associated with survival, other significant prognostic factors were age and gender. Non-Hispanic Black (mOS: 8 months, 95% CI: 7-10) and Native American (mOS: 8 months, 95% CI: 5-15) patients had the poorest outcomes, followed by Hispanics (mOS 9 months, 95% CI: 8-10). Non-Hispanic White and Asian patients fared better (mOS 11 and 12 months, respectively) (P value <0.001). Patients with household income ≥$75,000 had better survival outcomes than those earning <$75,000 annually (P value <0.001). On multivariate Cox analysis, age <55 years, females, localized disease, Asian or Caucasian ethnicity, and median household income ≥$75,000 were independently associated with a lower risk of death. CONCLUSIONS: This study identifies ethnic and socioeconomic disparities in iCCA patients that may impact prognosis. These findings highlight the need for targeted interventions to address inequities, ensuring access to care and improving survival outcomes for underserved populations.