3505 - Treatment Patterns and Outcomes in Elderly Patients with Cholangiocarcinoma

Purpose/Objective(s):

Many elderly patients are precluded from aggressive treatment due to existing comorbidities or morbidities associated with trimodality therapy. This population-based study seeks to describe treatment patterns and survival outcomes in elderly patients with cholangiocarcinoma.

Materials/Methods:

We queried the National Cancer Database (NCDB) for all newly diagnosed intrahepatic cholangiocarcinoma from 2004 and 2020. All 42,698 included patients had follow-up data available, and elderly was defined as age 65 and older. Kaplan-Meier, log-rank, and multivariate Cox proportional hazards regression was performed with overall survival (OS) as the primary outcome.

Results:

The median age of the entire cohort is 67 years old, and the 1-year OS was 43.6% (95% CI 43.2-44.1%). Patients who were elderly (n=25,329) had significantly worse OS than younger patients, with a 1-year OS of 39.1% versus 50.2%, respectively (p<0.01). The median follow-up time for elderly patients who were alive was 33.2 months. In the elderly patient cohort, for patients who did not have metastatic disease (n=9337), 36% of patients underwent surgical resection (n=3368), and only 3.3% underwent trimodality treatment. Elderly patients who underwent surgery had a significantly improved OS when compared to patients who did not (1-year OS 83.3% versus 38.9%, p<0.01). Elderly patients who underwent trimodality therapy had a significantly improved OS when compared to those who did not (1-year OS 92.4% versus 53.9%, p<0.01). The 1-year OS was not significantly different between the younger cohort and elderly cohort who received trimodality therapy (92.8% versus 92.4%, p=0.1). Patients with stage I disease had significantly improved OS compared to stage II and stage III disease (1-year OS 63.7% versus 53% versus 44.5%, respectively, p<0.01). Earlier stage disease and trimodality therapy remained significant on multivariate analysis as independent predictors for OS (p<0.01 for both). In patients who did not undergo surgery, a combination of CRT (n=579) had significantly improved 1-year OS (66.5% vs 35.8%) compared to those who underwent single modality therapy or no therapy (p<0.01).

Conclusion:

Although elderly patients have worse overall outcomes than younger patients with cholangiocarcinoma, this data suggests that trimodality therapy is associated with excellent OS outcomes in elderly patients. Surgery with chemoradiation therapy should still be pursued in select patients with resectable disease who can tolerate aggressive treatment and may currently be under-utilized in this cohort.