背景:确定肝胆肿瘤的预测发病率并识别风险增加的患者队列有助于制定有针对性的干预措施和资源分配。不同年龄组肝胆肿瘤亚型的预期发病率,种族,性别仍然未知。
方法:来自监测的历史流行病学数据,流行病学,和最终结果(SEER)数据库用于预测美国肝胆恶性肿瘤的未来发病率,并按年龄确定趋势,种族,和性别。包括2001年至2017年间诊断为肝胆恶性肿瘤的年龄≥18岁的患者。美国人口普查局2017年国家人口项目提供了2017年至2029年的预计人口。使用年龄-周期-队列预测模型来估计未来出生队列特定的发病率。使用R统计软件完成所有分析。
结果:我们纳入了2001年至2017年间诊断为肝胆恶性肿瘤的110381例历史患者,其亚型如下:肝细胞癌(HCC)(68%),肝内胆管癌(iCCA)(11.5%),胆囊癌(GC)(8%),肝外胆管癌(eCCA)(7.6%),壶腹癌(AC)(4%)。我们的模型预测HCC的发病率将增加一倍(2001年至2029年),从4.5到9.03/100,000,其中70-79岁的患者预计最显著的增加。相比之下,预计亚洲人口的发病率将继续下降。iCCA的发生率预计会增加,尤其是在白人群体中,2029年的利率是2001年的两倍(2.13vs.每100,000分别为0.88;p<0.001)。预计黑人人群中GC的发病率会增加。预计eCCA的发病率将显著增加,尤其是在西班牙裔人口中,而AC将保持稳定。
结论:预计未来几年肝胆恶性肿瘤的总发病率将增加,某些群体的风险增加。在考虑筛查时,这些发现可能有助于资源分配,治疗,和未来几年的研究。
BACKGROUND: Identifying the projected incidence of hepatobiliary cancers and recognizing patient cohorts at increased risk can help develop targeted interventions and resource allocation. The expected incidence of subtypes of hepatobiliary cancers in different age groups, races, and genders remains unknown.
METHODS: Historical epidemiological data from the Surveillance, Epidemiology, and End Results (SEER) database was used to project future incidence of hepatobiliary malignancies in the United States and identify trends by age, race, and gender. Patients ≥18 years of age diagnosed with a hepatobiliary malignancy between 2001 and 2017 were included. US Census Bureau 2017 National Population projects provided the projected population from 2017 to 2029. Age-Period-Cohort forecasting model was used to estimate future births cohort-specific incidence. All analyses were completed using R Statistical Software.
RESULTS: We included 110381 historical patients diagnosed with a hepatobiliary malignancy between 2001 and 2017 with the following subtypes: hepatocellular cancer (HCC) (68%), intrahepatic cholangiocarcinoma (iCCA) (11.5%), gallbladder cancer (GC) (8%), extrahepatic cholangiocarcinoma (eCCA) (7.6%), and ampullary cancer (AC) (4%). Our models predict the incidence of HCC to double (2001 to 2029) from 4.5 to 9.03 per 100,000, with the most significant increase anticipated in patients 70-79 years of age. In contrast, incidence is expected to continue to decline among the Asian population. Incidence of iCCA is projected to increase, especially in the white population, with rates in 2029 double those in 2001 (2.13 vs. 0.88 per 100,000, respectively; p < 0.001). The incidence of GC among the black population is expected to increase. The incidence of eCCA is expected to significantly increase, especially among the Hispanic population, while that of AC will remain stable.
CONCLUSIONS: The overall incidence of hepatobiliary malignancies is expected to increase in the coming years, with certain groups at increased risk. These findings may help with resource allocation when considering screening, treatment, and research in the coming years.