title: Increased incidence but improved median overall survival for biliary tract cancers diagnosed in Ontario from 1994 through 2012: A population-based study.
abstract: To the authors' knowledge, the incidence of biliary tract cancer (BTC) in Canada is unknown. In the current study, the authors sought to describe the epidemiology of BTC using a large population-based cancer database from Ontario, Canada.
  
  
  
  The current study was a population-based cohort study using the Ontario Cancer Registry. Patients with intrahepatic cholangiocarcinoma (IHCC), extrahepatic cholangiocarcinoma (EHCC), and gallbladder cancer (GBC) diagnosed between 1994 and 2012 were included. Age-standardized incidence and mortality rates were compared using incidence rate ratios (IRRs). Overall survival from the time of diagnosis was calculated for 3 eras: 1994 through 1999, 2000 through 2005, and 2006 through 2012. The number of patients receiving chemotherapy, radiotherapy, or surgery was determined using linked clinical data.
  
  
  
  A total of 9039 cases (1569 IHCC cases, 4337 EHCC cases, and 3133 GBC cases) were identified. The rate of BTC increased by 1.6% per year (IRR, 1.016; 95% confidence interval [95% CI], 1.008-1.024 [P<.001]). The incidence increased by 7.0% per year among cases of IHCC (IRR, 1.070; 95% CI, 1.058-1.081 [P<.001]) and 1.8% per year in cases of EHCC (IRR, 1.018; 95% CI, 1.009-1.027 [P<.001]), whereas the incidence of GBC remained unchanged (IRR, 0.991; 95% CI, 0.982-1.001 [P = .086]). The median survival for the cohort was 8.3 months, with improvement noted over the study period (6.1 months for 1994-1999 vs 8.5 months for 2000-2005 vs 10.3 months for 2006-2012 [P<.001]). The median survival was the longest for EHCC (11.3 months), followed by GBC (6.4 months) and IHCC (6.2 months). The percentage of patients receiving chemotherapy and/or radiotherapy increased over the study (P<.001), whereas the percentage of patients receiving surgery decreased (P<.001).
  
  
  
  An increased incidence of BTC during 1994 through 2012 was observed. Explanations for the observed temporal improvement in median survival require further exploration. Cancer 2016;122:2534-43. © 2016 American Cancer Society.
authors.affiliation: Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Queen's University, Kingston, Ontario, Canada.|Department of Medicine, Queen's University, Kingston, Ontario, Canada.|Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Flemming
authors.affiliation: Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Queen's University, Kingston, Ontario, Canada.|Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada.|Department of Oncology, Queen's University, Kingston, Ontario, Canada.
authors.forename: Jina
authors.initials: J
authors.lastname: Zhang-Salomons
authors.affiliation: Department of Surgery, Queen's University, Kingston, Ontario, Canada.
authors.forename: Sulaiman
authors.initials: S
authors.lastname: Nanji
authors.affiliation: Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Queen's University, Kingston, Ontario, Canada.|Department of Medicine, Queen's University, Kingston, Ontario, Canada.|Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada.|Department of Oncology, Queen's University, Kingston, Ontario, Canada.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Booth
mesh_terms: D000368:Aged; D001661:Biliary Tract Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009864:Ontario / Q000453:epidemiology; D011159:Population Surveillance; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Ontario Cancer Registry; chemotherapy; cholangiocarcinoma; gallbladder cancer; mortality