Taylor-Robinson S D, Toledano M B, Arora S, Keegan T J, Hargreaves S, Beck A, Khan S A, Elliott P, Thomas H C
Liver Unit, Department of Medicine A, Imperial College School of Medicine, St Mary's Campus, South Wharf Street, London W2 1PG, UK.
Gut. 2001 Jun;48(6):816-20. doi: 10.1136/gut.48.6.816.
The age standardised mortality rate per 100 000 population for all causes of liver tumours (International Classification of Disease 9 (ICD-9) 155) has almost doubled in England and Wales during the period 1979-1996. We further analysed the mortality statistics to determine which anatomical subcategories were involved.
Mortality statistics for liver tumours of ICD-9 155, 156, and subcategories, and for tumours of the pancreas (ICD-9 157), in England and Wales were investigated from the Office for National Statistics, London, from 1968 to 1996 inclusive. Data for 1997 and 1998 were also available on intrahepatic cholangiocarcinomas.
There has been a marked rise in age standardised mortality rates for intrahepatic cholangiocarcinoma. Since 1993, it represents the commonest recorded cause of liver tumour related death in England and Wales. This is evident in age groups older than 45 years. In contrast, mortality trends from other primary liver tumours, including hepatocellular carcinoma, were unremarkable.
The observed increase in mortality from intrahepatic cholangiocarcinoma may represent better case ascertainment and diagnosis due to improved diagnostic imaging, use of image guided biopsies, or increased use of ERCP. However, the trend started before ERCP was introduced nationally, mortality rates have continued to increase steadily thereafter, and there is no clear evidence that diagnostic transfers easily explains the findings. Alternatively, these observations may represent a true increase in intrahepatic bile duct tumours. Epidemiological studies are required to determine whether there is any geographical clustering of cases around the UK.
在1979 - 1996年期间，英格兰和威尔士每10万人口中因所有肝脏肿瘤病因（国际疾病分类第9版（ICD - 9）编码155）导致的年龄标准化死亡率几乎翻了一番。我们进一步分析了死亡率统计数据，以确定涉及哪些解剖学亚类。
从伦敦国家统计局调查了1968年至1996年（含）英格兰和威尔士ICD - 9编码155、156及其亚类的肝脏肿瘤以及胰腺肿瘤（ICD - 9编码157）的死亡率统计数据。1997年和1998年肝内胆管癌的数据也可获取。
肝内胆管癌的年龄标准化死亡率显著上升。自1993年以来，它是英格兰和威尔士记录的与肝脏肿瘤相关死亡的最常见原因。这在45岁以上年龄组中很明显。相比之下，包括肝细胞癌在内的其他原发性肝脏肿瘤的死亡率趋势不明显。
观察到的肝内胆管癌死亡率增加可能是由于诊断成像改善、影像引导活检的使用或ERCP使用增加导致病例确诊和诊断更好。然而，这一趋势在全国引入ERCP之前就已开始，此后死亡率持续稳步上升，并且没有明确证据表明诊断转移能够轻易解释这些发现。或者，这些观察结果可能代表肝内胆管肿瘤的真实增加。需要进行流行病学研究以确定英国各地是否存在病例的地理聚集情况。
