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Secular Trends in the Incidence of Cholangiocarcinoma in the USA and the Impact of Misclassification

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Abstract

Background and Aims

It has been reported that the incidence of intrahepatic cholangiocarcinoma (ICC) has increased in the USA, while extrahepatic cholangiocarcinoma (ECC) has decreased or remained stable. However, neither the recent trends nor the effects of the misclassification of Klatskin tumors are known.

Methods

Using the Surveillance, Epidemiology, and End Results program databases, we calculated the average annual age-adjusted incidence rates (AA-IRs) of ICC and ECC in 4-year time periods (1992–1995, 1996–1999, 2000–2003, 2004–2007). These AA-IRs were calculated with misclassified as well as correctly classified Klatskin tumors. AA-IRs were also calculated based on age, sex, and race. Multivariable Poisson regression models were used to evaluate the secular trends of ICC and ECC.

Results

The AA-IR of ICC was 0.92 in 1992–1995 and 0.93 in 2004–2007, while the AA-IR of ECC increased from 0.70 in 1992–1995 to 0.95 in 2004–2007. There was no significant trend in AA-IR of ICC (p = 0.07), while there was a significant increase in ECC across the 4-year time periods (p < 0.001). Klatskin tumors comprised 6.7 % of CCs with approximately 90 and 45 % misclassified as ICC during 1992–2000 and 2001–2007, respectively. Adjusted Poisson models showed no significant differences in the temporal trend of ICC or ECC due to misclassification of Klatskin tumors.

Conclusions

The incidence of ICC has remained stable between 1992 and 2007 with only slight fluctuations, while the incidence of ECC has been increasing. Misclassification of Klatskin tumors does not appear to play a significant role in the trends of CCs.

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Abbreviations

CC:

Cholangiocarcinoma

ICC:

Intrahepatic cholangiocarcinoma

ECC:

Extrahepatic cholangiocarcinoma

WHO:

World Health Organization

SEER:

Surveillance, Epidemiology, and End Results

ICD-O:

International Classification of Diseases for Oncology

AA-IR:

Age-adjusted incidence rate

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Acknowledgments

This work is partly funded by NIH Grant T32 DK083266-01A1, NIH Grant R01-CA-125487, NIH/National Institute of Diabetes and Digestive and Kidney Disease, Center Grant P30 DK56338 and the VA HSR&D Center for Innovations in Quality, Effectiveness and Safety (#CIN 13-413).

Conflict of interest

No conflicts of interest exist for Drs. Tyson, Ilyas, Duan, Green, Younes, El-Serag, or Davila.

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Authors and Affiliations

  1. Houston VA Health Services Research and Development Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA

    Gia L. Tyson, Jawad A. Ilyas, Zhigang Duan, Hashem B. El-Serag & Jessica A. Davila

  2. Sections of Gastroenterology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA

    Gia L. Tyson, Jawad A. Ilyas & Hashem B. El-Serag

  3. Sections of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA

    Gia L. Tyson, Jawad A. Ilyas, Zhigang Duan, Hashem B. El-Serag & Jessica A. Davila

  4. Department of Pathology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA

    Linda K. Green

  5. Laboratory Medicine, Department of Pathology, University of Texas Medical School at Houston, Houston, TX, USA

    Mamoun Younes

  6. 1430 Tulane Ave. SL-35, New Orleans, LA, USA

    Gia L. Tyson

Authors
  1. Gia L. Tyson
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  2. Jawad A. Ilyas
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  3. Zhigang Duan
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  6. Hashem B. El-Serag
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  7. Jessica A. Davila
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Correspondence to Gia L. Tyson.

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Disclaimer: The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.

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Tyson, G.L., Ilyas, J.A., Duan, Z. et al. Secular Trends in the Incidence of Cholangiocarcinoma in the USA and the Impact of Misclassification. Dig Dis Sci 59, 3103–3110 (2014). https://doi.org/10.1007/s10620-014-3276-2

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  • DOI: https://doi.org/10.1007/s10620-014-3276-2

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