Patients with intrahepatic cholangiocarcinoma (ICC) who received treatment only at a referral center, such as an academic or specialty cancer center, had improved overall survival (OS) compared to patients who only received care at community centers (P =.006).

The finding was part of a study conducted by Oregon Health and Science University in Portland and published in the Annals of Surgical Oncology. Researchers investigated the association between care received from each type of center and oncological outcomes in patients with ICC.

Overall survival for patients who received care at both community and referral centers had even further increased OS compared to community or referral center treatment only (P <.001 for both). The study also found that both treatment at referral centers only and combined center treatments involved patients receiving curative-intent and palliative therapies, which were associated with improved OS.

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The authors attributed these improvements to referral centers having knowledge of and access to more cutting-edge treatment options such as second-line therapies targeting fibroblast growth factor receptor rearrangements or fusions or liver-directed therapies including selective internal radiation therapy, external beam radiotherapy, and hepatic arterial infusion pump therapy.

The authors stated, “Given the association between referral center evaluation for patients with ICC and improved oncologic outcomes, we encourage outreach and partnership with community oncologists by referral centers within states with a predominately rural population, as well as consideration for institution-sponsored and insurance-reimbursed travel expenses or telehealth evaluations for specialized care for ICC and other rare hepatobiliary malignancies.”

Although it was unclear whether the patients receiving care at both referral and community centers transferred to a referral center after starting care at a community center or if they were comanaged by physicians at both locations, these patients tended to have improved OS compared to those treated at a single site.

Patients with locoregional ICC had a median OS of 17 months when treated at both centers, compared to rates of 6 months at community centers (P <.001) and 12 months (P =.076) at referral centers only. The median OS for patients with distantly metastatic ICC was 8 months for treatment at both centers, compared to rates of 2 months (P =.009) at community centers and 4 months (P =.013) at referral centers.

Patients with incomplete staging also had a median OS of 8 months at both centers, compared to rates of 3 months (P =.036) at community centers and 5 months (P <.001) at referral centers.


Sutton TL, Walker BS, Nabavizadeh N, et al. Geographic disparities in referral rates and oncologic outcomes of intrahepatic cholangiocarcinoma: a population-based study. Ann Surg Oncol. Published online August 27, 2021. doi:10.1245/s10434-021-10650-6