title: A significant cancer burden and high mortality of intrahepatic cholangiocarcinoma in Thailand: a nationwide database study.
abstract: BACKGROUND
  We aimed to examine the burden of intrahepatic cholangiocarcinoma (ICC) in Thailand and identify the prognostic factors for all-causes of death.
  
  
  METHODS
  We conducted a population-based study of ICC patients admitted during 2009-2013 using the Nationwide Hospital Admission Database, the National Health Security Office (NHSO). There was an average of 1,051,146 patients/year with diagnosis of gastrointestinal diseases (GI). All patients with a diagnosis of ICC (ICD10- C221) were included from a total of 72,479 admissions from 858 hospitals. The surgical resection procedures such as the radical pancreaticoduodenectomy, subtotal and partial hepatectomy were analyzed. Data for all patients were censored 1 year post-study or death, whichever came first.
  
  
  RESULTS
  A total of 34,325 patients with ICC during a 5-year study period (on average, 6865 patients/year, with the incidence rate of 14.6 per 100,000 population, per year. The ICC patients had a mean age of 63.8+/-11.6 years and 63% were males. The mean length of hospital stay was 6.4+/-7.3 days with a mean+/-SD cost of hospitalization of $595+/-$1160 USD per admission. There were 659 patients (1.9%) underwent surgical resection. The overall survival of ICC patients with surgery was significantly better than those patients without surgery. Hazard ratio of death for patients without surgery was 2.5 (95% CI of 2.3-2.7). Approximately 14% of the ICC patients died during hospitalization. The median overall survival of all patients after the first admission was 53 +/-0.6 days. From the multivariate analysis, factors related to all-causes of death were: patients' age >60 years (OR = 1.2, 95% CI; 1.1-1.3), length of hospital stay of >7 days (OR = 1.1, 95% CI; 1.02-1.2), male (OR = 1.3, 95% CI; 1.2-1.4), living in the northern part of Thailand (OR = 1.5, 95% CI; 1.3-1.8) and presence of complications during admission (OR = 1.3, 95% CI; 1.1-1.5).
  
  
  CONCLUSIONS
  The disease burden of patients with ICC in Thailand is significant with the incidence rate of 14.6 per 100,000 population, per year during 2009-2013 and showed high mortality rate of 14%.
authors.affiliation: Faculty of Medicine, Division of Gastroenterology, Chulalongkorn University, Patumwan, Bangkok, Thailand. battan5410@gmail.com.|Thai Red Cross, Pathumwan, Bangkok, Thailand. battan5410@gmail.com.|Department of Medicine, Faculty of Medicine, Chulalongkorn University, Rama 4 Road, Pathumwan District, Bangkok, 10330, Thailand. battan5410@gmail.com.
authors.forename: Sombat
authors.initials: S
authors.lastname: Treeprasertsuk
authors.affiliation: Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Ratchathewi, Bangkok, Thailand.
authors.forename: Kittiyod
authors.initials: K
authors.lastname: Poovorawan
authors.affiliation: Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Ratchathewi, Bangkok, Thailand.
authors.forename: Ngamphol
authors.initials: N
authors.lastname: Soonthornworasiri
authors.affiliation: Faculty of Medicine, Division of Gastroenterology, Chulalongkorn University, Patumwan, Bangkok, Thailand.|Thai Red Cross, Pathumwan, Bangkok, Thailand.
authors.forename: Roongruedee
authors.initials: R
authors.lastname: Chaiteerakij
authors.affiliation: Faculty of Medicine, Division of Gastroenterology, Chulalongkorn University, Patumwan, Bangkok, Thailand.|Thai Red Cross, Pathumwan, Bangkok, Thailand.
authors.forename: Kessarin
authors.initials: K
authors.lastname: Thanapirom
authors.affiliation: Faculty of Medicine, KhonKaen University, Muang District, KhonKaen, Thailand.
authors.forename: Pisaln
authors.initials: P
authors.lastname: Mairiang
authors.affiliation: Faculty of Medicine, KhonKaen University, Muang District, KhonKaen, Thailand.
authors.forename: Kookwan
authors.initials: K
authors.lastname: Sawadpanich
authors.affiliation: Thai Red Cross, Pathumwan, Bangkok, Thailand.
authors.forename: Kanokwan
authors.initials: K
authors.lastname: Sonsiri
authors.affiliation: Faculty of Medicine, Division of Gastroenterology, Chulalongkorn University, Patumwan, Bangkok, Thailand.
authors.forename: Varocha
authors.initials: V
authors.lastname: Mahachai
authors.affiliation: Medicine, Vichaiyut hospital and Medical Center, Ratchathewi, Bangkok, Thailand.
authors.forename: Kamthorn
authors.initials: K
authors.lastname: Phaosawasdi
mesh_terms: D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D018281:Cholangiocarcinoma / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D017281:Cost of Illness; D016208:Databases, Factual; D005260:Female; D006498:Hepatectomy / Q000401:mortality; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000401:mortality; D015996:Survival Rate; D013785:Thailand / Q000453:epidemiology
keywords: Cancer burden; Intrahepatic cholangiocarcinoma; Nationwide database; Thailand