Investigating Age-Related Differences in Survival Outcomes and Mutation Status of Patients with Intrahepatic...

Survival outcomes for intrahepatic cholangiocarcinoma (IHC) remain poor due to late-stage presentation and limited effective treatment options. Previous studies have suggested age-related differences in outcome, but the results are mixed, and there is substantial variation in the definition of "young."

A retrospective review analyzed 938 consecutive patients with a diagnosis of IHC between 2000 and 2018 at a single institution. Risk factors for IHC, clinical characteristics at diagnosis, and genomics were assessed for potential differences at the extremes of age (≤50 vs ≥70 years).

The final cohort (n = 430) included 142 patients 50 years or younger and 288 patients older than 70. The most common genetic alterations were IDH1mut (22%), p53mut (17%), KRASmut (9.8%), and FGFR2fus (6.3%). Young patients had a higher proportion of FGFR2fus (p = 0.020). The median overall survival (OS) for the entire cohort was 23 months (95% confidence interval [CI], 20-27 months). In the resected group, recurrence-free survival (RFS) was longer for the older patients (median 27 vs 17months), but OS did not differ significantly (23 vs 25 months; p = 0.3). By contrast, among the unresectable patients, OS was significantly better for the younger patients (p = 0.008), but no significant relationship was observed between age and resection status when OS was assessed (p = 0.7).

Genomic differences between older and younger patients did not appear to drive the differences in OS observed in this cohort. Intrahepatic cholangiocarcinoma patients 50 years or younger likely do not represent a distinct subgroup despite differences in presentation and clinical characteristics.