Wood R, Brewster D H, Fraser L A, Brown H, Hayes P C, Garden O J
Information and Statistics Division of NHSScotland, Trinity Park House, South Trinity Road, Edinburgh EH5 3SQ, UK.
Eur J Cancer. 2003 Sep;39(14):2087-92. doi: 10.1016/s0959-8049(03)00544-6.
The mortality from intrahepatic cholangiocarcinoma has increased recently in England and Wales and elsewhere. This study aims to examine recent trends in the incidence of intrahepatic cholangiocarcinoma in Scotland, to assess the extent to which changes in diagnostic practice may be influencing the observed trends, and to consider whether the results are compatible with a genuine increase in the risk of this cancer. Cancer registration (intrahepatic cholangiocarcinoma and anatomically adjacent cancers) data from Scotland 1968-1997 were analysed, including examination of trends in the percentage of cases recorded as being microscopically-verified. Since the late 1960s, the incidence of intrahepatic cholangiocarcinoma has increased approximately eight-fold in both sexes in Scotland. However, the proportion of cases verified microscopically has decreased substantially since the late 1970s, presumably due to an increasing reliance on radiological imaging for diagnosis. Despite this change in diagnostic practice, the incidence of microscopically-verified intrahepatic cholangiocarcinoma has also increased. While changes in diagnostic practice and misclassification could explain, at least part of, the observed increase in incidence of intrahepatic cholangiocarcinoma, a genuine increase in the risk of this cancer in the Scottish population seems probable. Further work is indicated to examine international trends in incidence, and to assess whether incidence differs within countries according to characteristics such as area of residence, socio-economic status, ethnic origin or occupation.
近期，英格兰、威尔士及其他地区肝内胆管癌的死亡率有所上升。本研究旨在调查苏格兰肝内胆管癌发病率的近期趋势，评估诊断实践的变化对所观察到的趋势的影响程度，并探讨这些结果是否与该癌症风险的真正增加相符。分析了1968年至1997年苏格兰癌症登记（肝内胆管癌及解剖学上相邻的癌症）数据，包括对记录为经显微镜确诊的病例百分比趋势的检查。自20世纪60年代末以来，苏格兰男女肝内胆管癌的发病率均增加了约八倍。然而，自20世纪70年代末以来，经显微镜确诊的病例比例大幅下降，这可能是由于越来越依赖放射影像学进行诊断。尽管诊断实践发生了这种变化，但经显微镜确诊的肝内胆管癌的发病率也有所上升。虽然诊断实践的变化和错误分类至少可以部分解释所观察到的肝内胆管癌发病率的增加，但苏格兰人群中这种癌症风险的真正增加似乎是可能的。需要进一步开展工作，以研究发病率的国际趋势，并评估发病率在各国是否因居住地区、社会经济地位、种族或职业等特征而有所不同。
