The epidemiological trends of biliary tract cancers in the United States of America

Abstract

Background Biliary tract cancers (BTCs) are a series of heterogeneous malignancies that are broadly grouped based on the anatomical site where they arise into subtypes including intrahepatic cholangiocarcinoma (ICC), extrahepatic cholangiocarcinoma (ECC), gallbladder cancer (GBC), and ampulla of Vater cancer (AVC). Methods and Results The present study provides an overview of the epidemiology of the various BTCs based on data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) database from 2000 to 2018. Distinct differences in both incidence and mortality rates were observed for these BTCs as a function of age, sex, ethnicity, and calendar year. In 2018, BTCs emerged as the fifth most prevalent form of alimentary tract cancer in the USA. While the incidence and mortality of ICC appear to be increasing, the incidence rates of GBC, ECC, and AVC have remained stable, as have the corresponding mortality rates. The most common and deadliest BTCs in 2018 were ICC and GBC among males and females, respectively. The ethnic groups exhibiting the highest incidence rates of these different BTCs were American Indians and Alaska Natives for GBC, and Asian and Pacific Islanders for ICC, ECC, and AVC. The incidence of all of these forms of BTC rose with age. There were some variations in BTCs in terms of staging, locoregional surgical treatments, adjuvant therapies, and prognostic outcomes from 2000 to 2018. Conclusions The epidemiological characteristics, staging, locoregional surgical treatments, adjuvant therapies, and prognostic outcomes were distinct for each of these BTCs.

Current Standards, Multidisciplinary Approaches, and Future Directions in the Management of Extrahepatic Cholangiocarcinoma

“…Extrahepatic CCA makes up 20-30% of all BTC in the USA and globally and is associated with certain conditions that significantly increase risk of eCCA including non-alcoholic fatty liver disease (odds ratio [OR] 2.9), cirrhosis (OR 3.8), alcohol-related liver disease (OR 2.6), and primary sclerosing cholangitis (PSC; OR 40.8), with the latter carrying up to a 36% lifetime risk of developing CCA [3][4][5]. Hepatitis B (HBV) and C (HCV) are associated with iCCA (predominantly) and eCCA (HBV OR 2.38; HCV OR 3.18) [4][5][6][7]. Conditions predisposing to eCCA include chronic pancreatitis, cholangitis, and choledocholithiasis [5,8] with the estimated incidence of around 1.02 cases per 100,000 annually [9].…”

Adjuvant Chemotherapy and Outcomes in Older Adult Patients With Biliary Tract Cancer

“…Biliary tract cancers are largely incurable, as they usually present at an advanced stage. Fewer than 40% of patients present with potentially resectable disease, and among them, approximately 70% experience recurrence . Adjuvant chemotherapy (AC) is therefore administered to reduce the risk of recurrence and improve overall survival (OS).…”

Evaluating the Therapeutic Potential of Durvalumab in Adults with Locally Advanced or Metastatic Biliary Tract Cancer: Evidence to Date

“…2 The incidence of BTCs is projected to increase in the coming years, with the largest contribution by intrahepatic CCA. 3,4 Historically, treatment of advanced BTC consisted of gemcitabine plus cisplatin based on ABC-02, which randomized patients with advanced or metastatic BTC to gemcitabine with or without cisplatin and demonstrated an improvement in median overall survival (mOS) with the combination regimen compared to single agent gemcitabine [11.7 vs 8.1 months, hazard ratio (HR) = 0.64, 95% confidence interval (CI) = 0.52-0.80, p<0.001]. 5 Following this trial, subsequent studies failed to demonstrate the superiority of alternative regimens.…”