title: Biliary tract malignancies: a population-based study on incidence, prognosis and management of patients.
abstract: BACKGROUND
  Biliary tract malignancies are uncommon and few population-based studies are available.
  
  
  METHODS
  This nationwide population-based study in Iceland included all patients diagnosed with intra- and extrahepatic cholangiocarcinoma, gallbladder and ampullary cancer from 1984 to 2012. Patients were identified through the Icelandic Cancer Registry. Clinical information was obtained from patient records.
  
  
  RESULTS
  Overall 245 patients were identified: 38 had intrahepatic cholangiocarcinoma, 66 extrahepatic cholangiocarcinoma, 73 gallbladder cancer (GBC) and 68 ampullary cancer. Overall incidence for bile tract malignancies was 1-3 per 100,000 person-years and less than 1 by sub-type. The overall bile tract malignancies in males increased from 1.3 (95% CI 0.8-1.8) to 2.5 (1.9-3.1) per 100,000 inhabitants. The incidence of GBC among females decreased from 1.1 (0.7-1.5) to 0.5 (0.2-0.7). Surgery decreased for extrahepatic cholangiocarcinoma (56 to 23%, p = .027), ampullary cancer (80 to 48%, p = .03) and overall bile tract cancer (61 to 32%, p < .0001) but use of chemotherapy increased (4 to 32%, p < .0001). Five-year relative survival rates for men were 15% and 24% for women. No significant improvement was found in survival.
  
  
  CONCLUSIONS
  Overall incidence of bile tract malignancies increased in males and GBC decreased in women. Long-term survival is poor and did not improve despite changes in treatment.
authors.affiliation: a Department of Gastroenterology and Hepatology , Landspitali University Hospital , Reykjavik , Iceland.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Juliusson
authors.affiliation: b Department of Pathology , Landspitali University Hospital , Reykjavik , Iceland.|c Faculty of Medicine , University of Iceland , Reykjavik , Iceland.|d Icelandic Cancer Registry, Icelandic Cancer Society , Reykjavik , Iceland.
authors.forename: Jon Gunnlaugur
authors.initials: JG
authors.lastname: Jonasson
authors.affiliation: a Department of Gastroenterology and Hepatology , Landspitali University Hospital , Reykjavik , Iceland.
authors.forename: Sara B
authors.initials: SB
authors.lastname: Jonsdottir
authors.affiliation: a Department of Gastroenterology and Hepatology , Landspitali University Hospital , Reykjavik , Iceland.
authors.forename: Henrik G
authors.initials: HG
authors.lastname: Garcia
authors.affiliation: d Icelandic Cancer Registry, Icelandic Cancer Society , Reykjavik , Iceland.
authors.forename: Elinborg
authors.initials: E
authors.lastname: Olafsdottir
authors.affiliation: c Faculty of Medicine , University of Iceland , Reykjavik , Iceland.|e Department of Surgery , Landspitali University Hospital , Reykjavik , Iceland.
authors.forename: Pall Helgi
authors.initials: PH
authors.lastname: Möller
authors.affiliation: a Department of Gastroenterology and Hepatology , Landspitali University Hospital , Reykjavik , Iceland.|c Faculty of Medicine , University of Iceland , Reykjavik , Iceland.
authors.forename: Einar S
authors.initials: ES
authors.lastname: Björnsson
mesh_terms: D000368:Aged; D014670:Ampulla of Vater / Q000473:pathology*; D001661:Biliary Tract Neoplasms / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D001662:Biliary Tract Surgical Procedures; D018281:Cholangiocarcinoma / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D004358:Drug Therapy; D005260:Female; D006801:Humans; D007055:Iceland / Q000453:epidemiology; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D011379:Prognosis; D012042:Registries; D017678:Sex Distribution; D015996:Survival Rate
keywords: Cholangiocarcinoma; gallbladder cancer; survival