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©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
Clinical and socioeconomic determinants of survival in biliary tract adenocarcinomas
Laura Sahyoun, Kay Chen, Cynthia Tsay, George Chen, Petr Protiva
Laura Sahyoun, Department of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, NY 10065, United States
Kay Chen, Gastroenterology Section, Jennifer Moreno VA San Diego Healthcare System, San Diego, CA 92161, United States
Kay Chen, Division of Gastroenterology, Department of Medicine, University of California San Diego, La Jolla, CA 92093, United States
Cynthia Tsay, Department of Gastroenterology and Hepatology, John Hopkins Hospital, Baltimore, MD 21287, United States
George Chen, Petr Protiva, Department of Digestive Diseases, Yale New Haven Hospital, New Haven, CT 06520, United States
Petr Protiva, Department of Gastroenterology, VA Connecticut Health Care System, West Haven, CT 06516, United States
Author contributions: All authors performed conceptualization, writing of original draft, review and editing; Sahyoun L performed methodology, investigation, and visualization; Protiva P performed data curation, statistical analysis, methodology, validation, and supervision.
Institutional review board statement: All information regarding each patient from the Surveillance, Epidemiology, and End Results (SEER) database is deidentified; therefore, data from the National Cancer Institute SEER Program does not require institutional review board (IRB) approval or exemption determination.
Informed consent statement: Signed informed consent was not needed for this study.
Conflict-of-interest statement: The authors have no conflicts of interest to disclose. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Laura Sahyoun, MD, Academic Fellow, Department of Gastroenterology and Hepatology, Weill Cornell Medicine, 525 East 68 Street, New York, NY 10065, United States.
las4024@med.cornell.edu
Received: September 17, 2023
Peer-review started: September 17, 2023
First decision: December 1, 2023
Revised: December 16, 2023
Accepted: February 1, 2024
Article in press: February 1, 2024
Published online: April 15, 2024
Processing time: 206 Days and 5.4 Hours
BACKGROUND
Despite advances in detection and treatments, biliary tract cancers continue to have poor survival outcomes. Currently, there is limited data investigating the significance of socioeconomic status, race/ethnicity, and environmental factors in biliary tract cancer survival.
AIM
To investigate how socioeconomic status and race/ethnicity are associated with survival.
METHODS
Data from the Surveillance, Epidemiology, and End Results database for biliary and gallbladder adenocarcinomas were extracted from 1975 to 2016. Socioeconomic data included smoking, poverty level, education, adjusted household income, and percentage of foreign-born persons and urban population. Survival was calculated with Cox proportional hazards models for death in the 5-year period following diagnosis.
RESULTS
Our study included 15883 gallbladder, 11466 intrahepatic biliary, 12869 extrahepatic biliary and 7268 ampulla of Vater adenocarcinoma cases. When analyzing county-specific demographics, patients from counties with higher incomes were associated with higher survival rates [hazard ratio (HR) = 0.97, P <0.05]. Similarly, counties with a higher percentage of patients with a college level education and counties with a higher urban population had higher 5-year survival rates (HR = 0.96, P = 0.002 and HR = 0.97, P = 0.004, respectively).
CONCLUSION
Worse survival outcomes were observed in lower income counties while higher income and education level were associated with higher 5-year overall survival among gallbladder and biliary malignancies.
Core Tip: Biliary tract cancers exhibit poor survival outcomes despite advances in treatment. There is a paucity of data addressing the role of socioeconomic factors on biliary tract adenocarcinoma survival. This study has a large sample size of hepatobiliary cancers despite low incidence rates due to the utilization of the Surveillance, Epidemiology, and End Results national database. Study findings are unique and significant for a higher 5-year survival among those with a college education and in the urban population.
