Graduation Year


Document Type




Degree Name

Doctor of Philosophy (Ph.D.)

Degree Granting Department

Epidemiology and Biostatistics

Major Professor

Aurora Sanchez-Anguiano, Ph.D.

Co-Major Professor

Jennifer Permuth, Ph.D.

Committee Member

Getachew Dagne, Ph.D.

Committee Member

Amy Alman, Ph.D.

Committee Member

Daniel Anaya, M.D.


biliary cancer, curative-intent surgery, elderly, pre-operative therapy


Intrahepatic Cholangiocarcinomas (ICC) are fatal malignancies common among the elderly. Patients are diagnosed late and often relapse, even after curative-intent surgery (CIS). In this context, additional systemic chemotherapy (multimodal treatment) is recommended for most patients but reported survival benefits are minimal and are limited to small single institutional studies. For this reason, using a national cancer registry, we sought to characterize multimodal treatment trends and utilization in general and neoadjuvant chemotherapy, specifically, as well as evaluate their survival effects among the larger population. We hypothesized that, 1). Elderly ICC patients would have survival benefits equivalent to younger patients, 2). Neoadjuvant chemotherapy (NC) provides improved survival over adjuvant chemotherapy or surgery alone. Study participants were selected from the National Cancer Database (NCDB), a hospital-based cancer registry which accounts for 70% of newly diagnosed cancer cases in the United States annually. We examined trends from 2004 through 2014 using Cochran-Armitage trend tests, identified independent predictors of multimodal treatment using logistic regression models, evaluated survival using univariate KM plots with log-rank tests and adjusted for confounders using propensity-score stratified and matched multivariable Cox regression models. Survival benefit in elderly versus young patients was no different for CIS (HR 1.14 [0.92-1.41]) and for CIS-multimodality treatment (1.35 [0.91-2.01]). NC utilization was associated with improved OS (HR: 0.78 [95%CI 0.54-1.11]. Elderly patients were less likely to receive CIS than younger ones but had an equivalent survival when treated. This study also demonstrated that patients with more advanced disease may benefit from a multimodal approach using NC.

Included in

Oncology Commons