Cholangiocarcinoma across England: Temporal changes in incidence, survival and routes to diagnosis by region and level of socioeconomic deprivation
Daniela Tataru, Shahid A. Khan, Roger J. Hill, Helen Morement, Kwok Wong, Lizz Paley, Mireille B. Toledano
Abstract
•What is already known on this topic•Cholangiocarcinoma (CCA) incidence and mortality rates are rising globally, particularly for intrahepatic CCA (iCCA). However, it is unknown if there are temporal or regional differences in incidence, mortality and survival rates of biliary tract sub-types, or whether these differ by gender, socioeconomic status, or diagnosis route.•This work aimed to perform the most in-depth study of the epidemiology of CCA and other biliary tract cancers (BTC) across a single nation than has ever been previously reported.•What this study adds•BTC cases, of which CCA was the most common, doubled during the study period with increases across all socioeconomic deprivation quintiles, and over 20% were under 65 years old when diagnosed•For CCA patients, mortality rates were almost 40% higher in the most socioeconomically deprived compared to the least.•iCCA had the highest incidence and the lowest survival rates.•There was regional variation in incidence, mortality and survival•Emergency presentation was the most common route of diagnosis for all BTC subtypes’•Net survival improved for all BTC•How this study might affect research, practice or policy•The causes for these differences and ongoing rising rates overall require further focused research.•This study highlights the need for earlier diagnosis and better awareness of this condition amongst the public and health care professionals ObjectivesThis work aimed to perform an in-depth analysis of cholangiocarcinoma (CCA) and other biliary tract cancers (BTC) incidence, mortality, survival and route to diagnosis (RtD).DesignData on all BTC diagnosed in England between 2001 and 2018 were extracted from NHS Digital’s National Cancer Registration Dataset. Age-standardised incidence (ASRs), mortality (ASMRs) and net survival rates were calculated as well as Kaplan-Meier overall survival (OS) estimates and routes to diagnosis trends. Analyses were stratified by gender, socioeconomic deprivation, tumour subtype and region.ResultsASR for CCA rose from 2.9 in 2001-2003 to 4.6 in 2016-2018 and from 1.0 to 1.8 for gallbladder cancers (GBC). ASMR trends mirror those of incidence, with most deaths due to iCCA. Over 20% of CCA patients were under 65 years old. The ASR and ASMR were consistently higher in the most socioeconomically deprived group for CCA and GBC. The most common RtD was the emergency route (CCA 49.6%, GBC 46.2% and Ampulla of Vater (AoV) 43.0%). The least deprived CCA and AoV patients had better overall survival (p<0.001). Net survival rates rose for all BTC, with 3-year CCA net survival increasing from 9.2% in 2001 to 12.6%, in 2016-2018. There was notable geographical variation in ASR, ASMR and net survival for all BTC.ConclusionBTC incidence and mortality are increasing, with differences observed between tumour types, socioeconomic deprivation groups, RtDs and geographical regions. This highlights the need for targeted interventions, earlier diagnosis and better awareness of this condition amongst the public and health care professionals. This work aimed to perform an in-depth analysis of cholangiocarcinoma (CCA) and other biliary tract cancers (BTC) incidence, mortality, survival and route to diagnosis (RtD). Data on all BTC diagnosed in England between 2001 and 2018 were extracted from NHS Digital’s National Cancer Registration Dataset. Age-standardised incidence (ASRs), mortality (ASMRs) and net survival rates were calculated as well as Kaplan-Meier overall survival (OS) estimates and routes to diagnosis trends. Analyses were stratified by gender, socioeconomic deprivation, tumour subtype and region. ASR for CCA rose from 2.9 in 2001-2003 to 4.6 in 2016-2018 and from 1.0 to 1.8 for gallbladder cancers (GBC). ASMR trends mirror those of incidence, with most deaths due to iCCA. Over 20% of CCA patients were under 65 years old. The ASR and ASMR were consistently higher in the most socioeconomically deprived group for CCA and GBC. The most common RtD was the emergency route (CCA 49.6%, GBC 46.2% and Ampulla of Vater (AoV) 43.0%). The least deprived CCA and AoV patients had better overall survival (p<0.001). Net survival rates rose for all BTC, with 3-year CCA net survival increasing from 9.2% in 2001 to 12.6%, in 2016-2018. There was notable geographical variation in ASR, ASMR and net survival for all BTC. BTC incidence and mortality are increasing, with differences observed between tumour types, socioeconomic deprivation groups, RtDs and geographical regions. This highlights the need for targeted interventions, earlier diagnosis and better awareness of this condition amongst the public and health care professionals.