Epidemiologic patterns of biliary tract cancer in the United States: 2001-2015

Abstract

Background: Biliary tract cancer (BTC) includes intrahepatic cholangiocarcinoma (ICC), extrahepatic cholangiocarcinoma, gallbladder cancer, and ampulla of Vater cancer (AVC). Although BTC is rare in the US, incidence is increasing and elevated in certain populations. This study examined BTC epidemiology in the US by age, sex, race/ethnicity, geographic region, and anatomic site.

Methods: BTC incidence, prevalence, mortality, and survival from 2001 to 2015 were evaluated using the National Cancer Institute's Surveillance, Epidemiology, and End Results Program and the Centers for Disease Control and Prevention's National Program of Cancer Registries databases. Incidence and mortality rates were calculated and reported as age-standardized rates. Data were assessed by age, anatomic sites, geographic region, and race/ethnicity, and a joinpoint regression model was used to predict trends for age-adjusted BTC incidence and mortality rates.

Results: BTC incidence increased during the study period (annual percent change = 1.76, 95% confidence interval [1.59-1.92]), with the highest increase in ICC (6.65 [6.11-7.19]). Incidence of unspecified BTC initially increased but has recently begun to drop. Hispanic, Asian/Pacific Islander, Black, or American Indian/Alaska Native race/ethnicity was associated with higher BTC mortality rates than White race/ethnicity. Patients with ICC had the highest mortality rate (age-standardized rate = 1.87/100,000 person-years [1.85-1.88]). Five-year survival was 15.2% for all BTC, ranging from 8.5% (ICC) to 34.5% (AVC), and patients with distant disease at diagnosis had lower survival (3%) compared with those with regional (19.1%) or locally advanced disease (31.5%).

Conclusions: BTC incidence increased, survival was low across all subtypes, and mortality was greatest in patients with ICC. This underscores the serious, increasing unmet need among patients with BTC. Treatment options are limited, although clinical studies investigating immunotherapy, targeted therapies, and alternative chemotherapy combinations are ongoing. Epidemiological insights may improve patient care and inform the integration of novel therapies for BTC.

Keywords: Ampulla of Vater cancer; Biliary tract cancer; Extrahepatic cholangiocarcinoma; Gallbladder cancer; Intrahepatic cholangiocarcinoma.

Fig. 1

BTC incidence rate ratio of different races/ethnicities: 2001–2015 [27]. Note: Incidence rates are ASR and reported as cases per 100,000 person-years. Incidence rate ratio = ASR (race/ethnicity)/White race ASR used as a reference group. Error bars show 95% CI. ASR age-standardized rate, AVC ampulla of Vater cancer, BTC biliary tract cancer, CI confidence interval, ECC extrahepatic cholangiocarcinoma, GBC gallbladder cancer, ICC intrahepatic cholangiocarcinoma, NOS not otherwise specified

Fig. 2

Joinpoint modeling of BTC incidence [27]. Note: ^ Indicates that the APC is significantly different from zero at the alpha = 0.05 level. APC annual percent change, BTC biliary tract cancer, NOS not otherwise specified

Fig. 3

Incidence rate of BTC overall and by anatomic site in the United States: 2001–2015 [27]. Note: Incidence rates are age-standardized and reported as cases per 100,000 person-years. BTC biliary tract cancer, NOS not otherwise specified, US United States

Fig. 4

Joinpoint modeling of BTC mortality [27]. Note: ^ Indicates that the APC is significantly different from zero at the alpha = 0.05 level. APC annual percent change, BTC biliary tract cancer

Fig. 5

Five-year relative survival for patients with BTC by anatomic site and race/ethnicity [29]. Note: Error bars show 95% CI. AVC ampulla of Vater cancer, BTC biliary tract cancer, CI confidence interval, ECC extrahepatic cholangiocarcinoma, GBC gallbladder cancer, ICC intrahepatic cholangiocarcinoma, NOS not otherwise specified