ESMO gastrointestinal oncology · 2026
Care delivery among patients with early-onset versus average-onset cholangiocarcinoma: a nationwide retrospective analysis.
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Grewal U S, Nottke A, Loeffler B T, Concors S J, Hornstein N J, Brown T J, Lamarca A, Valle J W
Аннотация
BACKGROUND: Cholangiocarcinoma (CCA) is an aggressive biliary malignancy with increasing incidence and poor prognosis. Although traditionally considered a disease of older adults, early-onset CCA (EOCCA; age <50 years) may represent a clinically distinct subgroup. Data evaluating diagnostic and treatment trajectories in EOCCA remain limited.
PATIENTS AND METHODS: Using the Komodo Healthcare Map claims database (2017-2024), patients with CCA were identified using International Classification of Diseases, 10th Revision, codes and categorized as having EOCCA or average-onset CCA. Outcomes included time from first diagnosed symptom to CCA diagnosis, diagnostic delay (≥30 days), time to first intervention, and type of first intervention. Multivariable logistic, log-gamma, and competing-risk regression models evaluated associations between demographic and insurance factors and care delivery outcomes.
RESULTS: Among 116 106 patients with CCA, 5146 (4.4%) had EOCCA. Of 43 137 patients with symptoms documented in their claims data, EOCCA was independently associated with longer time to diagnosis [expβ 1.13, 95% confidence interval (CI) 1.07-1.20, P < 0.001] and higher odds of diagnostic delay of ≥30 days [odds ratio (OR) 1.24, 95% CI 1.12-1.36, P < 0.001]. Overall time to first intervention did not differ significantly between cohorts; however, patients with EOCCA were more likely to receive cancer-directed therapy (OR 1.12, 95% CI 1.01-1.25). Within the EOCCA cohort, longer diagnostic intervals reduced the likelihood of intervention, and disparities in treatment receipt were observed among racial minorities and publicly insured patients.
CONCLUSIONS: The EOCCA cohort represents a clinically vulnerable population characterized by significant diagnostic delays and sociodemographic disparities in care delivery. Earlier recognition and system-level interventions to improve access and streamline diagnostic pathways are needed to optimize outcomes in younger patients with CCA.
PATIENTS AND METHODS: Using the Komodo Healthcare Map claims database (2017-2024), patients with CCA were identified using International Classification of Diseases, 10th Revision, codes and categorized as having EOCCA or average-onset CCA. Outcomes included time from first diagnosed symptom to CCA diagnosis, diagnostic delay (≥30 days), time to first intervention, and type of first intervention. Multivariable logistic, log-gamma, and competing-risk regression models evaluated associations between demographic and insurance factors and care delivery outcomes.
RESULTS: Among 116 106 patients with CCA, 5146 (4.4%) had EOCCA. Of 43 137 patients with symptoms documented in their claims data, EOCCA was independently associated with longer time to diagnosis [expβ 1.13, 95% confidence interval (CI) 1.07-1.20, P < 0.001] and higher odds of diagnostic delay of ≥30 days [odds ratio (OR) 1.24, 95% CI 1.12-1.36, P < 0.001]. Overall time to first intervention did not differ significantly between cohorts; however, patients with EOCCA were more likely to receive cancer-directed therapy (OR 1.12, 95% CI 1.01-1.25). Within the EOCCA cohort, longer diagnostic intervals reduced the likelihood of intervention, and disparities in treatment receipt were observed among racial minorities and publicly insured patients.
CONCLUSIONS: The EOCCA cohort represents a clinically vulnerable population characterized by significant diagnostic delays and sociodemographic disparities in care delivery. Earlier recognition and system-level interventions to improve access and streamline diagnostic pathways are needed to optimize outcomes in younger patients with CCA.