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Cohort study to assess geographical variation in cholangiocarcinoma treatment in England

World Journal of Gastrointestinal Oncology 2023年第12期15卷 2077-2092页

作者： Sophie Jose Amy Zalin-Miller Craig Knott Lizz Paley daniela tataru Helen Morement Mireille B Toledano Shahid A Khan Health Data Analysis Health Data Insight CICCambridge CB215XEUnited Kingdom National Disease Registration Service National Health Service EnglandLondon SE18UGUnited Kingdom Department of Executive AMMF-The Cholangiocarcinoma CharityEssex CM241QWUnited Kingdom MRC Centre for Environment and Health Imperial College LondonLondon SW72BXUnited Kingdom Mohn Centre for Children's Health and Wellbeing Imperial College LondonLondon SW72BXUnited Kingdom Liver Unit Division of Digestive DiseasesImperial College LondonLondon SW72BXUnited Kingdom

BACKGROUND Outcomes for cholangiocarcinoma(CCA)are extremely poor owing to the complexities in diagnosing and managing a rare disease with heterogenous *** curative surgery,which is only an option for a minority of patients diagnosed at an early stage,few systemic therapy options are currently recommended to relieve symptoms and prolong *** insertion to manage disease complications requires highly specialised *** is lacking as to how CCA patients are managed in a real-world setting and whether there is any variation in treatments received by CCA *** To assess geographic variation in treatments received amongst CCA patients in *** Data used in this cohort study were drawn from the National Cancer Registration Dataset(NCRD),Hospital Episode Statistics and the Systemic Anti-Cancer Therapy Dataset.A cohort of 8853 CCA patients diagnosed between 2014-2017 in the National Health Service in England was identified from the *** curative surgery for all patients and systemic therapy and stent insertion for 7751 individuals who did not receive surgery were identified as three end-points of *** probability models assessed variation in each of the three treatment modalities according to Cancer Alliance of residence at diagnosis,and for socio-demographic and clinical characteristics at *** Of 8853 CCA patients,1102(12.4%)received potentially curative *** mean[95%confidence interval(CI)]percentage-point difference from the population average ranged from-3.96(-6.34 to-1.59)%to 3.77(0.54 to 6.99)%across Cancer Alliances in England after adjustment for patient sociodemographic and clinical characteristics,showing statistically significant *** 7751 who did not receive surgery,1542(19.9%)received systemic therapy,with mean[95%CI]percentage-point difference from the population average between-3.84(-8.04 to 0.35)%to 9.28(1.76 to 16.80)%across Cancer Alliances after adjustm

关键词： Cholangiocarcinoma Biliary tract cancer Liver cancer Treatment Surgery Systemic therapy Chemotherapy Stent England

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Regional variation in routes to diagnosis of cholangiocarcinoma in England from 2006 to 2017

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World Journal of Gastroenterology 2023年第24期29卷 3825-3842页

作者： Amy Zalin-Miller Sophie Jose Craig Knott Lizz Paley daniela tataru Helen Morement Mireille B Toledano Shahid A Khan Department of Analytics Health Data Insight CICCambridge CB215XEUnited Kingdom Disease Registration Service NHS EnglandLondon E144PUUnited Kingdom CEO AMMFLondon CM241QWUnited Kingdom MRC Centre for Environment and Health School of Public HealthImperial College LondonLondon SW72BXUnited Kingdom Liver Unit Division of Digestive DiseasesImperial College LondonLondon W21NYUnited Kingdom

BACKGROUND Incidence of cholangiocarcinoma(CCA)is rising,with overall prognosis remaining very *** for the high mortality of CCA include its late presentation in most patients,when curative options are no longer feasible,and poor response to systemic therapies for advanced *** presentation presents a large barrier to improving outcomes and is often associated with diagnosis via mergency presentation(EP).Earlier diagnoses may be made by Two Week Wait(TWW)referrals through General practitioner(GP).We hypothesise that TWW referrals and EP routes to diagnosis differ across regions in *** To investigate routes to diagnosis of CCA over time,regional variation and influencing *** We linked patient records from the National Cancer Registration Dataset to Hospital Episode Statistics,Cancer Waiting Times and Cancer Screening Programme datasets to define routes to diagnosis and certain patient characteristics for patients diagnosed 2006-2017 in *** used linear probability models to investigate geographic variation by assessing the proportions of patients diagnosed via TWW referral or EP across Cancer Alliances in England,adjusting for potential *** between the proportion of people diagnosed by TWW referral and EP was investigated with Spearman’s correlation *** Of 23632 patients diagnosed between 2006-2017 in England,the most common route to diagnosis was EP(49.6%).Non-TWW GP referrals accounted for 20.5%of diagnosis routes,13.8%were diagnosed by TWW referral,and the remainder 16.2%were diagnosed via an‘other’or Unknown *** proportion diagnosed via a TWW referral doubled between 2006-2017 rising from 9.9%to 19.8%,conversely EP diagnosis route declined,falling from 51.3%to 46.0%.Statistically significant variation in both the TWW referral and EP proportions was found across Cancer ***,presence of comorbidity and underlying liver disease were independently associated with both a lowe

关键词： Cholangiocarcinoma Route to diagnosis Two Week Wait Emergency presentation Regional variation

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