# Intrahepatic cholangiocarcinoma trends and treatment lines: real-world evidence from the French National Hospital Discharge database

## TL;DR

This study uses French hospital data to show rising intrahepatic cholangiocarcinoma cases and poor patient outcomes, with few receiving second-line treatments.

## Contribution

The study introduces a novel AI algorithm (ATLAS) to analyze treatment lines in real-world iCCA patient data from a national hospital database.

## Key findings

- The incidence of iCCA in France increased from 3.08 to 4.12 per 100,000 adult person-years between 2016 and 2021.
- Only 37.7% of patients receiving first-line systemic therapy for iCCA went on to receive second-line treatment.
- The median time between first-line and second-line treatment was 7.0 months.

## Abstract

Little is known about the therapeutic trajectory of patients treated in hospitals for intrahepatic cholangiocarcinoma (iCCA) and patterns of care in daily clinical practice.

An observational retrospective study was conducted on the French National Hospital Discharge Database. All patients with a new diagnosis of iCCA who had a first hospital stay (S1) from January 2016 to December 2021 were included. They were followed up until December 2021, or in-hospital death, whichever occurred first. Crude annual hospitalization rates were computed. Treatment lines were identified with an artificial intelligence algorithm [Analysis of Treatment Lines using Alignment of Sequences (ATLAS)]. A multistate model was used to compute the transition rates between lines.

Overall, 13 491 patients were included and the mean (standard deviation) follow-up duration was 13.1 months (17.9 months). The median age at S1 was 72.0 years and 55.9% were male. Nearly 20.7% were admitted via emergency services for S1, and 32.1% had metastases. Between 2016 and 2021, the crude annual rate of new iCCA cases increased from 3.08 [95% confidence interval (CI) 2.94-3.24] in 2016 (n = 1598) to 4.12 (95% CI 3.95-4.29) per 100 000 adult person-years in 2021 (n = 2188). Among 4855 patients receiving first-line systemic therapy (L1), 37.7% (95% CI 36.0% to 39.3%) received a second-line 2 (L2) during the follow-up. The median time between the start of L1 and the beginning of L2 was 7.0 months.

This study provides up-to-date national real-world data on iCCA, revealing an increasing burden year by year in France, a poor outcome of patients with iCCA on L1 systemic therapy, and the low proportion of patients receiving an L2.

•The incidence of iCCA is increasing in France.•Our real-world study confirms the poor outcomes and the low percentage of patients with iCCA receiving second-line treatment.•Artificial intelligence improves the information obtained from the Hospital Discharge Database.

The incidence of iCCA is increasing in France.

Our real-world study confirms the poor outcomes and the low percentage of patients with iCCA receiving second-line treatment.

Artificial intelligence improves the information obtained from the Hospital Discharge Database.