title: Temporal trends in liver-directed therapy of patients with intrahepatic cholangiocarcinoma in the United States: a population-based analysis.
abstract: OBJECTIVE
  Data on outcomes after liver-directed therapy for intrahepatic cholangiocarcinoma (ICC) are limited due to the rarity of the disease. We sought to define overall utilization and temporal trends of liver-directed therapy for ICC.
  
  
  METHODS
  We identified 5,388 patients with ICC using the Surveillance Epidemiology and End Results (SEER) database between 1983 and 2010. Patients were characterized based on the type of liver-directed therapy received: surgical resection, ablation therapy, and radiation therapy.
  
  
  RESULTS
  The majority of patients did not undergo liver-directed therapy (n = 4,156, 77.1%). Among those undergoing liver-directed therapy, surgical resection was most commonly performed (n = 672, 54.5%) and its utilization increased threefold over time (P = 0.001). The use of ablation therapy alone was used in 5.2% of patients and increased nearly sixfold over time (P = 0.39) whereas the use of radiation therapy alone decreased by nearly half (P < 0.001). Overall median survival was 10 months. Poor predictors of survival include tumor-based factors such as regional and distant disease, as well as poorly differentiated and large tumors (>5 cm).
  
  
  CONCLUSIONS
  There was a moderate improvement in overall survival in patients with ICC between 1983 and 2010. The majority of patients with ICC are not undergoing liver-directed therapy. Among those who do undergo liver-directed therapy, the use of ablation therapy and surgery are increasing with nearly three in five patients undergoing resection.
authors.affiliation: Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland; Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Neda
authors.initials: N
authors.lastname: Amini
authors.forename: Aslam
authors.initials: A
authors.lastname: Ejaz
authors.forename: Gaya
authors.initials: G
authors.lastname: Spolverato
authors.forename: Yuhree
authors.initials: Y
authors.lastname: Kim
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Herman
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Pawlik
mesh_terms: D055011:Ablation Techniques / Q000706:statistics & numerical data / Q000639:trends*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms; D001653:Bile Ducts, Intrahepatic; D018281:Cholangiocarcinoma / Q000401:mortality / Q000628:therapy*; D005260:Female; D006498:Hepatectomy / Q000706:statistics & numerical data / Q000639:trends*; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011878:Radiotherapy / Q000706:statistics & numerical data / Q000639:trends*; D012189:Retrospective Studies; D018426:SEER Program; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States
keywords: cholangiocarcinoma; intrahepatic; liver-directed; outcome; population-based