Multi-institutional care is associated with improved survival in biliary tract cancer

Biliary tract cancers (BTCs) often require coordinated, multi-institutional care (MC). While MC has been associated with worse outcomes in some cancers, its impact on BTC remains unknown. This study aimed to examine predictors of MC and its association with survival after curative-intent resection for BTC.

Using the National Cancer Database (2004-2022), we retrospectively identified adults undergoing curative-intent resection for stage I-III BTC. MC was defined as receiving treatment across multiple facilities. Multivariable logistic regression identified predictors of MC. Overall survival (OS) was assessed with Kaplan-Meier (KM) and Cox proportional-hazards models.

Among 13,250 patients, 2,824 (21.3%) received MC. Younger age, non-Hispanic White race, private insurance, higher socioeconomic status, and greater travel distance independently predicted MC (all P<0.001). Treatment at community cancer programs was the strongest predictor [odds ratio (OR) 2.25, 95% confidence interval (CI): 1.79-2.83]. MC was associated with improved OS compared with single-facility care [hazard ratio (HR) 0.85, 95% CI: 0.80-0.89]. In stratified analyses, patients treated at multiple facilities, regardless of surgical volume, had the most favorable survival, whereas single low-volume centers had the poorest outcomes (log-rank P<0.0001).

MC was associated with improved survival after resection in BTC. These findings support a coordinated model centralizing complex surgery while delivering other treatments locally. Implementation should prioritize equitable access through streamlined referral pathways and shared perioperative protocols.