Combined Hepatocellular-cholangiocarcinoma: A Population Level Analysis Of Incidence And Mortality Trends

ObjectiveThe purpose of this study was to explore trends in incidence,mortality,and survival for combined hepatocellular-cholangiocarcinoma(cHCC-CC)utilizing a population-based database to attract people’s attention to this disease and provide reference for more effective clinical prevention and treatment.Methods:The National Cancer Database of the United States was utilized to investigate the incidence and mortality for cHCC-CC from 2000 to 2014.Trends in age-adjusted incidence and mortality were characterized by the Joinpoint Regression program.The Kaplan-Meier method and log-rank test were utilized to implement survival analyses.Cox regression was utilized to estimate independent predictors of mortality.Results:The incidence of cHCC-CC was 0.26 per 1,000,000 individuals in 2000 and 0.59 per 1,000,000 individuals in 2014,with an annual percent change(APC)(i.e.,the extent of increase in incidence)of 3.9%(95% confidence interval [CI] 1.7–6.1;P<0.05).The mortality of cHCC-CC also displayed a sustained increase(APC was4.6%,95% CI: 1.9–7.4;P<0.05).Compared to patients not undergoing surgery,patients undergoing surgical treatment experienced a significant increase in median survival(28 vs.3 months;P < 0.001).The median survival increased in patients with tumor size≤5 cm(20 vs.9 months;P < 0.001).Based on univariate Cox regression analysis,African-American race,distant stage,regionalized stage,tumor size > 5 cm,and no surgery were independently associated with an increased risk of death Conclusions:We found a sustained and rapid increase both in incidence and mortality of cHCC-CC,manifesting that there has been no significant improvement in patient outcomes,nor progress in prevention and treatment.Additional resources should bedevoted to cHCC-CC research.