Association between treatment facility volume, therapy types and overall survival in patients with intrahepatic cholangiocarcinoma

Anuhya Kommalapati, Sri Harsha Tella, Gaurav Goyal, Mitesh Borad, Steven R. Alberts, Lewis Roberts, Joleen M. Hubbard, Lori Durgin, Sean Cleary, Amit Mahipal

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Background: To determine the association between the number of patients with intra-hepatic cholangiocarcinoma (IHCC) treated annually at a treatment facility (volume) and overall survival (outcome). Methods: Patients with IHCC reported to the National Cancer Database (years 2004–2015) were included. We classified facilities by tertiles (T; mean IHCC patients treated/year): T1: <2.56; T2: 2.57–5.39 and T3: ≥5.40. Volume–outcome relationship was determined by using Cox regression adjusting for patient demographics, comorbidities, tumor characteristics, insurance type and therapy received. Results: There were 11,344 IHCC patients treated at 1106 facilities. On multivariable analysis, facility volume was independently associated with all-cause mortality (p < 0.001). The unadjusted median OS by facility volume was: T1: 5 months (m), T2: 8.1 m, and T3: 13.1 m (p < 0.001). Compared with patients treated at T3 facilities, patients treated at lower-tertile facilities had significantly higher risk of death [T2 hazard ratio (HR), 1.12 [95% CI, 1.05–1.23]; T1 HR, 1.21 [95% CI, 1.11–1.33]. Patients treated at high-volume centers were more likely to get surgery (34.6 vs 13.1%) and adjuvant therapy. Conclusion: IHCC patients treated at high-volume facilities had a significant improvement in OS and were more likely to receive surgery and adjuvant therapy as compared to that of patients at low-volume facilities.

Original languageEnglish (US)
Pages (from-to)379-386
Number of pages8
Issue number3
StatePublished - Mar 2019

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology


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