Kumar Disha, Bansal Varun, Raza Syed A, Thrift Aaron P, Malaty Hoda M, Sealock Robert J
Department of Internal Medicine, Baylor College of Medicine, Houston, Texas.
Section of Gastroenterology and Hepatology, Department of Internal Medicine, Baylor College of Medicine, Houston, Texas.
Gastro Hep Adv. 2022 Feb 3;1(2):180-185. doi: 10.1016/j.gastha.2021.12.003. eCollection 2022.
Cholangiocarcinoma is a relatively rare malignancy with high mortality. In the U.S., incidence rates of cholangiocarcinoma have increased, particularly affecting younger age groups and Hispanic and Asian individuals. We investigated the incidence of cholangiocarcinoma in a largely under-represented, minority population.
We performed a retrospective cohort study from 2005 to 2017 among adults in a county-funded healthcare system in Harris County, Texas. Incidence rate ratios were computed to compare age-standardized rates using U.S. standard population between 2 time periods: 2005-2011 and 2012-2017.
We identified 139 cholangiocarcinoma cases (64% intrahepatic, 36% extrahepatic). The median age at diagnosis was 57 years; 62% were Hispanic, and 56% were born outside the U.S. The incidence rate increased from 1.2 to 2.4 per 100,000 person-years (rate ratio 2.1 [95% confidence interval {CI}: 1.5, 3.0]). Hispanic individuals and those aged 40-69 years had the highest rate of incidence increase (respectively, rate ratio: 2.5 [95% CI: 1.6, 4.0] and rate ratio: 2.0 [95% CI: 1.2, 3.0]) between time periods. In 2012-2017, the risk of cholangiocarcinoma among patients with diabetes was 1.4 times relative to those without (relative risk: 1.4; 95% CI: 1.1, 1.5) and 1.2 times among those who were overweight/obese relative to those who were not (relative risk: 1.2; 95% CI: 1.1, 1.6).
Incidence of cholangiocarcinoma doubled during the 12-year study period, with Hispanic and middle-aged individuals disproportionately affected. Individuals with diabetes mellitus and those who were overweight or obese had a high risk of being diagnosed with cholangiocarcinoma in the later time period. Further studies should focus on preventing and improving earlier diagnosis of cholangiocarcinoma among Hispanics.
胆管癌是一种相对罕见但死亡率高的恶性肿瘤。在美国，胆管癌的发病率有所上升，尤其影响年轻人群以及西班牙裔和亚裔个体。我们调查了一个代表性严重不足的少数族裔人群中胆管癌的发病率。
我们在得克萨斯州哈里斯县一个由县资助的医疗系统中，对2005年至2017年的成年人进行了一项回顾性队列研究。计算发病率比，以使用美国标准人群比较两个时间段（2005 - 2011年和2012 - 2017年）之间的年龄标准化率。
我们确定了139例胆管癌病例（64%为肝内胆管癌，36%为肝外胆管癌）。诊断时的中位年龄为57岁；62%为西班牙裔，56%出生在美国境外。发病率从每10万人年1.2例增至2.4例（发病率比为2.1 [95%置信区间{CI}：1.5，3.0]）。西班牙裔个体以及40 - 69岁的人群在两个时间段之间发病率上升幅度最大（发病率比分别为：2.5 [95% CI：1.6，4.0]和发病率比：2.0 [95% CI：1.2，3.0]）。在2012 - 2017年，糖尿病患者患胆管癌的风险相对于非糖尿病患者为1.4倍（相对风险：1.4；95% CI：1.1，1.5），超重/肥胖者相对于非超重/肥胖者为1.2倍（相对风险：1.2；95% CI：1.1，1.6）。
在为期12年的研究期间，胆管癌发病率翻倍，西班牙裔和中年个体受影响尤为严重。糖尿病患者以及超重或肥胖者在后期被诊断为胆管癌的风险较高。进一步的研究应聚焦于预防和改善西班牙裔人群中胆管癌的早期诊断。
