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. 2015 Apr 2;10(3):e0120574.
doi: 10.1371/journal.pone.0120574. eCollection 2015.

Geographic variation of intrahepatic cholangiocarcinoma, extrahepatic cholangiocarcinoma, and hepatocellular carcinoma in the United States

Sean F Altekruse  1 , Jessica L Petrick  2 , Alicia I Rolin  1 , James E Cuccinelli  3 , Zhaohui Zou  3 , Zaria Tatalovich  1 , Katherine A McGlynn  2
Affiliations

Geographic variation of intrahepatic cholangiocarcinoma, extrahepatic cholangiocarcinoma, and hepatocellular carcinoma in the United States

Sean F Altekruse et al. PLoS One. .

Abstract

Background: Intrahepatic (ICC) and extrahepatic cholangiocarcinomas (ECC) are tumors that arise from cholangiocytes in the bile duct, but ICCs are coded as primary liver cancers while ECCs are coded as biliary tract cancers. The etiology of these tumors is not well understood. It has been suggested that the etiology of ICC is more similar to that of another type of liver cancer, hepatocellular carcinoma (HCC), than to the etiology of ECC. If this is true, geographic incidence patterns and trends in ICC incidence should be more similar to that of HCC than ECC.

Methods: To examine this hypothesis, data from the North American Association of Central Cancer Registries Cancer in North America data file were analyzed. Incidence rates and joinpoint trends were calculated by demographic subgroup. County-level incidence rates were mapped.

Results: Overall incidence rates, racial distribution, male:female ratio, and peak ages were more similar between ICC and ECC than with HCC. During 2000-2009, average annual incidence rates of ECC increased. During 2005-2009, average annual ICC incidence rates also increased. High rates for all three cancer sites were found in the Pacific region, particularly Hawaii and Alaska. Rates of ICC and ECC were also high in the Northeast and the upper Midwest, while rates of HCC were high in the South.

Conclusions: Demographic patterns and geographical variation were more closely related between ICC and ECC than HCC, suggesting that the etiology of ICC and ECC may be similar. Increasing rates of both tumors suggest that further etiology studies are warranted.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist. Disclaimer: Findings and conclusions are the authors and do not necessarily represent official positions of the Centers for Disease Control and Prevention or National Cancer Institute.

Figures

Fig 1
Fig 1. Modeled United States county-level intrahepatic cholangiocarcinoma incidence rates, 2000–2009.
Fig 2
Fig 2. Modeled United States county-level extrahepatic cholangiocarcinoma incidence rates, 2000–2009.
Fig 3
Fig 3. Modeled United States county-level hepatocellular carcinoma incidence rates, 2000–2009.
See this image and copyright information in PMC

References

    1. Fritz A PC, Jack A, Shanmugaratnam K, Sobin LH, Parkin MD, editors. International classification of diseases for oncology (ICD-O) 3rd ed. Geneva (Switzerland): World Health Organization; 2000.
    1. Chapman RW. Risk factors for biliary tract carcinogenesis. Annals of oncology: official journal of the European Society for Medical Oncology / ESMO. 1999;10 Suppl 4:308–11. - PubMed
    1. Tomimatsu M, Ishiguro N, Taniai M, Okuda H, Saito A, Obata H, et al. Hepatitis C virus antibody in patients with primary liver cancer (hepatocellular carcinoma, cholangiocarcinoma, and combined hepatocellular-cholangiocarcinoma) in Japan. Cancer. 1993;72(3):683–8. - PubMed
    1. Shin HR, Lee CU, Park HJ, Seol SY, Chung JM, Choi HC, et al. Hepatitis B and C virus, Clonorchis sinensis for the risk of liver cancer: a case-control study in Pusan, Korea. International journal of epidemiology. 1996;25(5):933–40. - PubMed
    1. Kobayashi M, Ikeda K, Saitoh S, Suzuki F, Tsubota A, Suzuki Y, et al. Incidence of primary cholangiocellular carcinoma of the liver in japanese patients with hepatitis C virus-related cirrhosis. Cancer. 2000;88(11):2471–7. - PubMed

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