European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology · 2026
Treatment evolution and stage-specific survival in extrahepatic cholangiocarcinoma: a SEER study.
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Wang Zhengqiang
Аннотация
INTRODUCTION: Whether survival in extrahepatic cholangiocarcinoma (eCCA) has improved over time, and whether any gains reflect earlier stage at diagnosis or evolving treatment strategies, remains unclear. We evaluated temporal changes in stage, treatment patterns, overall survival (OS), and cancer-specific mortality (CSM) in eCCA.
MATERIALS AND METHODS: Patients with primary extrahepatic bile duct cancer (C24.0), malignant behavior, and histology codes 8140/3 or 8160/3 diagnosed in the SEER database from 2004 to 2022 were included. Diagnostic year was grouped into 2004-2008, 2009-2013, 2014-2018, and 2019-2022. Stage was classified as localized, regional, distant, or unknown. First-course treatment was recoded as no recorded active treatment, surgery alone, non-surgical therapy, or surgery plus additional recorded therapy. Multivariable Cox and Fine-Gray models were used for OS and CSM.
RESULTS: Among 11,198 patients, there was no clear shift toward earlier-stage disease over time; localized disease remained stable (17.3% vs 15.2%), while unknown stage decreased from 16.6% to 10.3%. Treatment patterns changed substantially, with no recorded active treatment decreasing from 49.2% to 37.2%, non-surgical therapy increasing from 25.0% to 33.3%, and surgery plus additional therapy increasing from 12.1% to 20.7%. Later era was associated with improved OS, with adjusted hazard ratios of 0.94, 0.89, and 0.79 across successive eras versus 2004-2008; these attenuated to 0.98, 0.95, and 0.87 after treatment adjustment. Similar patterns were observed for CSM. Survival gains varied by stage and were concentrated within 24 months after diagnosis.
CONCLUSION: Survival in eCCA improved over time without a clear shift toward earlier-stage disease. The attenuation of era effects after treatment adjustment suggests that evolving treatment strategies contributed substantially to recent outcome gains.
MATERIALS AND METHODS: Patients with primary extrahepatic bile duct cancer (C24.0), malignant behavior, and histology codes 8140/3 or 8160/3 diagnosed in the SEER database from 2004 to 2022 were included. Diagnostic year was grouped into 2004-2008, 2009-2013, 2014-2018, and 2019-2022. Stage was classified as localized, regional, distant, or unknown. First-course treatment was recoded as no recorded active treatment, surgery alone, non-surgical therapy, or surgery plus additional recorded therapy. Multivariable Cox and Fine-Gray models were used for OS and CSM.
RESULTS: Among 11,198 patients, there was no clear shift toward earlier-stage disease over time; localized disease remained stable (17.3% vs 15.2%), while unknown stage decreased from 16.6% to 10.3%. Treatment patterns changed substantially, with no recorded active treatment decreasing from 49.2% to 37.2%, non-surgical therapy increasing from 25.0% to 33.3%, and surgery plus additional therapy increasing from 12.1% to 20.7%. Later era was associated with improved OS, with adjusted hazard ratios of 0.94, 0.89, and 0.79 across successive eras versus 2004-2008; these attenuated to 0.98, 0.95, and 0.87 after treatment adjustment. Similar patterns were observed for CSM. Survival gains varied by stage and were concentrated within 24 months after diagnosis.
CONCLUSION: Survival in eCCA improved over time without a clear shift toward earlier-stage disease. The attenuation of era effects after treatment adjustment suggests that evolving treatment strategies contributed substantially to recent outcome gains.