Forty-Year Trends in Cholangiocarcinoma Incidence in the U.S.: Intrahepatic Disease on the Rise.
Forty-Year Trends in Cholangiocarcinoma Incidence in the U.S.: Intrahepatic Disease on the Rise.
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DOI：
10.1634/theoncologist.2015-0446
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发表时间：
2016-05
期刊：
影响因子：
--
通讯作者：
Brooks GA
中科院分区：
文献类型：
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作者：
Saha SK;Zhu AX;Fuchs CS;Brooks GA
在美国，肝内胆管癌的公认发病率持续上升，而肝外胆管癌的发病率则保持稳定。在同一时期，不明原发癌的发病率急剧下降。胆管癌的诊断和分类的挑战使得难以量化这种高度侵袭性恶性肿瘤的真实发病率。我们分析了监测、流行病学和最终结果数据，以评估1973年至2012年期间肝内和肝外胆管癌年龄标准化发病率的长期趋势，并校正了系统编码错误。由于肝内胆管细胞癌（ICC）可能经常被误诊为原发灶不明的癌症（CUP），我们也分析了CUP发病率的趋势。1973年至2012年间，美国报告的ICC发病率从每10万人0.44例增加到1.18例，年百分比变化（APC）为2.30%;这一趋势在过去十年中加速，APC为4.36%。在40年期间，肝外胆管癌的发病率从0.95/100，000适度增加至1.02/100，000（APC，0.14%）。在1973年至2012年期间，具有可能与胆管癌一致的组织学特征的CUP的发生率下降了51%（APC，-1.87%），而具有鳞状或非上皮组织学特征的CUP的发生率略有增加（APC，0.42%）。在美国，ICC的公认发病率持续上升，而ECC的发病率则保持稳定。在同一时期，CUP的发病率急剧下降。胆管癌（特别是肝内胆管癌[ICC]）和原发性不明癌（CUP）之间的临床区别可能具有挑战性。最近的发现已经确定了ICC中的复发性和潜在的靶向基因组异常，突出了改善诊断的重要性。这项研究表明，在美国，ICC的发病率正在上升，而肝外胆管癌的发病率是稳定的。与此同时，CUP的发病率急剧下降，这表明ICC和CUP之间的区别的改善可能是ICC发病率增加的主要驱动因素。ICC发病率的不断上升需要进一步研究预防和治疗方法。
The recognized incidence of intrahepatic cholangiocarcinoma in the U.S. continues to rise, whereas the incidence of extrahepatic cholangiocarcinoma is stable. The incidence of carcinoma of unknown primary has fallen dramatically during the same time period. Challenges in the diagnosis and classification of cholangiocarcinoma have made it difficult to quantify the true incidence of this highly aggressive malignancy. We analyzed the Surveillance, Epidemiology, and End Results data to assess long-term trends in the age-standardized incidence of intrahepatic and extrahepatic cholangiocarcinoma between 1973 and 2012, correcting for systematic coding errors. Because intrahepatic cholangiocarcinoma (ICC) may frequently be misdiagnosed as cancer of unknown primary (CUP), we also analyzed trends in the incidence of CUP. Between 1973 and 2012, the reported U.S. incidence of ICC increased from 0.44 to 1.18 cases per 100,000, representing an annual percentage change (APC) of 2.30%; this trend has accelerated during the past decade to an APC of 4.36%. The incidence of extrahepatic cholangiocarcinoma increased modestly from 0.95 to 1.02 per 100,000 during the 40-year period (APC, 0.14%). The incidence of CUP with histologic features potentially consistent with cholangiocarcinoma decreased by 51% between 1973 and 2012 (APC, −1.87%), whereas the incidence of CUP with squamous or nonepithelial histologic features increased modestly (APC, 0.42%). The recognized incidence of ICC in the U.S. continues to rise, whereas the incidence of ECC is stable. The incidence of CUP has fallen dramatically during the same time period. Clinical distinctions between cholangiocarcinoma (particularly intrahepatic cholangiocarcinoma [ICC]) and cancer of unknown primary (CUP) can be challenging. Recent discoveries have identified recurrent and potentially targetable genomic abnormalities in ICC, highlighting the importance of improving diagnosis. This study demonstrates that the incidence of ICC is increasing in the U.S., whereas the incidence of extrahepatic cholangiocarcinoma is stable. Concomitantly, the incidence of CUP has declined dramatically, suggesting that improved distinction between ICC and CUP may be a major driver of the increasing recognized incidence of ICC. The increasing incidence of ICC warrants further study of prevention and treatment approaches.