title: Epidemiological trends in incidence and mortality of hepatobiliary cancers in Germany.
abstract: OBJECTIVE
  While marked changes in the frequency of hepatobiliary malignancies, most notably hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC), have been observed in different populations, no such data have been reported for Germany. We aimed to provide epidemiological data on recent trends in liver-related mortality, specifically mortality from hepatobiliary malignancies, in Germany.
  
  
  METHODS
  We used incidence and mortality data to determine changes in the frequency of malignant and non-malignant liver disease in Germany over the past 30 years.
  
  
  RESULTS
  While overall liver disease mortality has slightly declined in Germany, deaths from hepatobiliary malignancies have declined in women, but remained constant in men. Among hepatobiliary malignancies, ICC stands out, because mortality has more than tripled both in men and women between 1998 and 2008. This is mirrored by a marked increase in new cases reported to local cancer registries, that is, incidence. Over the same time period, HCC and extrahepatic cholangiocarcinoma (ECC) have remained largely constant while gall bladder cancers (GBC) have declined twofold. The rapid rise in ICC is in line with finding from different regions worldwide, but in contrast to recent data from Denmark and France, two of Germany's direct neighbors.
  
  
  CONCLUSIONS
  The incidence of and mortality from ICC are rising markedly in Germany. The risk factors underlying this trend are as yet unclear.
authors.affiliation: Department of Gastroenterology, Hepatology and Endocrinology, Medizinische Hochschule, Hannover Medical School, Hannover, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: von Hahn
authors.forename: Sandra
authors.initials: S
authors.lastname: Ciesek
authors.forename: Gerd
authors.initials: G
authors.lastname: Wegener
authors.forename: Ruben R
authors.initials: RR
authors.lastname: Plentz
authors.forename: Tobias J
authors.initials: TJ
authors.lastname: Weismüller
authors.forename: Heiner
authors.initials: H
authors.lastname: Wedemeyer
authors.forename: Michael P
authors.initials: MP
authors.lastname: Manns
authors.forename: Tim F
authors.initials: TF
authors.lastname: Greten
authors.forename: Nisar P
authors.initials: NP
authors.lastname: Malek
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000401:mortality*; D006528:Carcinoma, Hepatocellular / Q000401:mortality*; D002648:Child; D018281:Cholangiocarcinoma / Q000401:mortality*; D005260:Female; D005706:Gallbladder Neoplasms / Q000401:mortality*; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D008113:Liver Neoplasms / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D055815:Young Adult