Treatment patterns and outcomes in patients with early onset cholangiocarcinoma: A large database analysis.

e23294 Background: Although the average age of onset of cholangiocarcinoma (CCA) is ≥ 65 years, recent data have demonstrated an alarming rise in incidence of CCA in the United States (US) among people younger than 50 years of age. However, robust data regarding the characteristics and outcomes of CCA among young patients are lacking. Methods: We used TriNetX, a national database comprising approximately 74 million patients across 54 healthcare organizations in the US, to perform the current analysis. We retrospectively identified patients with CCA (using ICD-10 code C22.1) from Jul 2009 to Jan 2022. We then performed comparative analysis between patients ≤ 49 years (early-onset CCA or EOCCA) and ≥ 50 years old (average-onset CCA or AOCCA). We performed a comparative analysis of baseline characteristics, treatment patterns and overall outcomes. We used the Chi-square test for the comparative analysis and Kaplan-Meier estimates were plotted for survival analysis. A p-value of < 0.05 was considered statistically significant. Results: We included a total of 1,343 patients with EOCCA. Compared to AOCCA, patients in the EOCCA group were more likely to be females (51% vs 48%, p < 0.0001), African Americans (13% vs 9%, p < 0.0001) and have a history of primary sclerosing cholangitis (7% vs 1%, p < 0.0001). Patients in the EOCCA group were more likely to undergo surgical resection (9.7% vs 8%, p = 0.007), liver transplant (4.5% vs 1.6%, p < 0.0001) and adjuvant chemotherapy (39.2% vs 33.5%, p < 0.0001). Young patients were also more like to receive palliative chemotherapy (16.7% vs 12.6%, P < 0.00001) and FGFR-directed targeted therapy (1.5% vs 0.3%, p < 0.00001). Compared to older patients, we noted a significantly higher overall survival among young patients undergoing surgical resection (85 months vs 43 months, p = 0.008) and patients with advanced disease (28 months vs 15 months, p < 0.0001), however, no difference in overall survival was noted between young and older patients undergoing liver transplant (88 months vs 117 months, p = 0.6). Conclusions: We present a large real-world analysis highlighting treatment patterns and outcomes in patients with EOCCA. Young patients received more surgical resections, both adjuvant therapies and palliative therapies, and had a significantly longer overall survival than their older counterparts. Although more patients underwent liver transplant in the EOCCA group, post-transplant survival was not significantly better compared to their older counterparts. Prospective clinical studies tailored to assess surgical and systemic therapeutic approaches specific to EOCCA patients are warranted.