Suraju Mohammed O, Gordon Darren M, Kahl Amanda R, McCracken Ana, Maduokolam Erica, Grimmett Jordan, Guedeze Komlan, Nash Sarah, Hassan Aziz
Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
College of Public Health, University of Iowa, Iowa City, Iowa, USA.
J Surg Oncol. 2025 Mar;131(3):450-456. doi: 10.1002/jso.27939. Epub 2024 Oct 4.
Intrahepatic cholangiocarcinoma (ICC) is the second most common malignancy of the liver and has the worst prognosis of any tumor arising from the liver, with a 5-year survival as low as 10%. However, whether the rurality of a patient's residence impacts care received and survival has not been well studied. We aimed to assess differences in care patterns associated with the rurality of patient's residences and their impact on survival outcomes, hypothesizing that patients in rural areas would experience lower survival.
Adult patients diagnosed with ICC between 2010 and 2020 were identified in the Iowa Cancer Registry. Chi-square tests were used to compare values categorical variables by rural/urban status. Cox proportional hazards regression was used to determine associations with cancer-specific mortality.
Of 672 patients diagnosed with ICC during the study period, 53%, 27%, and 21% resided in metropolitan, micropolitan, and rural areas, respectively. There were no significant differences in age, sex, stage at diagnosis, the proportion receiving chemotherapy within 12 weeks of diagnosis, and undergoing surgery across all groups. Additionally, the proportion receiving definitive care at a National Cancer Institute (NCI) designated center was comparable across the three groups (37% metro vs. 43% micro vs. 35% rural). However, rural residents had the highest proportion of traveling ≥ 50 miles for definitive care (22% metro vs. 41% micro vs. 56% rural). In multivariable analysis of patients with Stage 1-3 disease, younger age, receipt of chemotherapy, surgery, and definitive care at an NCI center were independently associated with decreased mortality risk. However, rural residence was not significantly associated with survival (HR: 0.64 [95% CI: 0.38-1.06]).
Similar to other complex cancer diagnoses, we found that definitive care at an NCI center was associated with decreased mortality risk for patients with ICC. Although rural residence was not independently associated with survival in this cohort, rural residents traveled significantly longer distances to access definitive care. This highlights a crucial need to improve access to specialized centers for complex cancer care.
肝内胆管癌（ICC）是肝脏第二常见的恶性肿瘤，是肝脏来源的所有肿瘤中预后最差的，5年生存率低至10%。然而，患者居住地区的乡村属性是否会影响其接受的治疗及生存情况，尚未得到充分研究。我们旨在评估与患者居住地区乡村属性相关的治疗模式差异及其对生存结果的影响，假设农村地区的患者生存率会更低。
在爱荷华癌症登记处识别出2010年至2020年间被诊断为ICC的成年患者。采用卡方检验按农村/城市状态比较分类变量的值。使用Cox比例风险回归来确定与癌症特异性死亡率的关联。
在研究期间诊断为ICC的672例患者中，分别有53%、27%和21%居住在大都市、微都市和农村地区。所有组在年龄、性别、诊断时的分期、诊断后12周内接受化疗的比例以及接受手术方面均无显著差异。此外，在国立癌症研究所（NCI）指定中心接受确定性治疗的比例在三组中相当（大都市组为37%，微都市组为43%，农村组为35%）。然而，农村居民因确定性治疗而出行≥50英里的比例最高（大都市组为22%，微都市组为41%，农村组为56%）。在对1-3期疾病患者的多变量分析中，年龄较小、接受化疗、手术以及在NCI中心接受确定性治疗与死亡风险降低独立相关。然而，农村居住与生存无显著关联（风险比：0.64 [95%置信区间：0.38 - 1.06]）。
与其他复杂癌症诊断情况类似，我们发现NCI中心的确定性治疗与ICC患者的死亡风险降低相关。尽管在该队列中农村居住与生存无独立关联，但农村居民为获得确定性治疗出行的距离显著更长。这凸显了改善复杂癌症治疗的专科中心可及性的迫切需求。
