Ransome Eke, Tong Li, Espinosa Jairo, Chou Jesse, Somnay Vishal, Munene Gitonga
Division of Epidemiology and Biostatistics, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA.
Department of General Surgery, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA.
J Gastrointest Oncol. 2019 Apr;10(2):339-347. doi: 10.21037/jgo.2018.12.07.
Intrahepatic cholangiocarcinoma (IHC) is a malignancy with an increasing incidence. Surgery is the only treatment modality associated with long term survival. The objective of this study is to utilize a nationwide representative database to quantify the trends in incidence, and surgery for IHC in the United States from 2004-2014, as well as identify any disparities in the receipt of surgery.
All patients admitted with a diagnosis of IHC between 2005 and 2014 were identified from the Nationwide Inpatient Sample (NIS) database. Trends in the number of IHC admissions and surgery procedures as well as outcomes were examined, and a multivariate analysis was used to determine the effects of demographic and clinical co-variables on resection rates.
An estimated total of 104,045 IHC related admissions occurred between 2005 and 2014. The hospitalization rate for IHC increased by nearly 2-fold in 2014 [38.9 per 100,000 (95% CI, 35.7-42.2)] from 18.1 per 100,000 (95% CI, 15.8-20.3) in 2005. Liver resections increased 248% (P<0.01) with an increasing majority being performed at teaching hospitals and 56% being minor resections. There was an increase in estimated hospital charges from $87,124 to $148,613 (P<0.001) and decrease in LOS from 12 days to 10 days (P<0.01). Inpatient mortality for IHC decreased significantly from 11% to 8.4% (P=0.004), from year 2005 to 2014 respectively. Age >80 years (OR =0.45; 95% CI, 0.33-0.60), Black race (OR =0.50; 95% CI, 0.39-063), Hispanic race (OR =0.59; 95% CI, 0.45-0.79), Medicaid insurance (OR =0.58; 95% CI, 0.42-0.79) and Elixhauser comorbidity score >3 (OR =0.58; 95% CI, 0.47-0.73) were associated with decreased rates of resection.
Overall hospitalization and volume of surgery for IHC has increased dramatically over the past decade. There has been an increase in cost, decrease in LOS and inpatient mortality during the period. Socioeconomic and racial disparities were observed in the receipt of surgery for IHC. Additional work is needed to understand the complex interplay between socioeconomic status and race in in the treatment of IHC.
肝内胆管癌（IHC）是一种发病率不断上升的恶性肿瘤。手术是唯一与长期生存相关的治疗方式。本研究的目的是利用一个全国代表性数据库，量化2004 - 2014年美国肝内胆管癌的发病率和手术趋势，并确定手术接受方面的任何差异。
从全国住院样本（NIS）数据库中识别出2005年至2014年间所有诊断为肝内胆管癌的住院患者。检查了肝内胆管癌入院人数、手术程序数量及结果的趋势，并使用多变量分析来确定人口统计学和临床协变量对切除率的影响。
2005年至2014年间估计共有104,045例与肝内胆管癌相关的入院病例。2014年肝内胆管癌的住院率从2005年的每10万人18.1例（95%可信区间，15.8 - 20.3）增加到近2倍，即每10万人38.9例（95%可信区间，35.7 - 42.2）。肝切除术增加了248%（P<0.01），其中越来越多的手术在教学医院进行，56%为小范围切除。估计住院费用从87,124美元增加到148,613美元（P<0.001），住院时间从12天减少到10天（P<0.01）。从2005年到2014年，肝内胆管癌的住院死亡率分别从11%显著下降到8.4%（P = 0.004）。年龄>80岁（比值比 = 0.45；95%可信区间，0.33 - 0.60）、黑人种族（比值比 = 0.50；95%可信区间，0.39 - 0.63）、西班牙裔种族（比值比 = 0.59；95%可信区间，0.45 - 0.79）、医疗补助保险（比值比 = 0.58；95%可信区间，0.42 - 0.79）和埃利克斯豪泽合并症评分>3（比值比 = 0.58；95%可信区间，0.47 - 0.73）与较低的切除率相关。
在过去十年中，肝内胆管癌的总体住院率和手术量显著增加。在此期间，费用增加，住院时间减少，住院死亡率降低。在肝内胆管癌手术接受方面存在社会经济和种族差异。需要进一步开展工作来了解社会经济地位和种族在肝内胆管癌治疗中的复杂相互作用。
