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a Liver Unit,
Department of Medicine A, Imperial College School of Medicine, St
Mary's Campus, South Wharf Street, London W2 1PG, UK, b Department of Epidemiology and Public Health,
Imperial College School of Medicine, St Mary's Campus, South Wharf
Street, London W2 1PG, UK, c Kensington and
Chelsea and Westminster Health Authority, 50, Eastbourne Terrace,
London W2 6LX, UK, d Department
of Biological Sciences, Wye College, University of London, Wye,
Ashford, Kent TN25 5AH, UK
Correspondence to: Dr S D Taylor-Robinson, Liver Unit, Department of Medicine A, 10th Floor, QEQM Wing, Imperial College School of Medicine, St Mary's Hospital, South Wharf Street, London W2 1PG, UK. s.taylor-robinson{at}ic.ac.uk
Accepted for publication 19 December 2000
BACKGROUND
The age
standardised mortality rate per 100 000 population for all causes of
liver tumours (International Classification of Disease 9 (ICD-9) 155)
has almost doubled in England and Wales during the period 1979-1996.
We further analysed the mortality statistics to determine which
anatomical subcategories were involved.
METHODSMortality
statistics for liver tumours of ICD-9 155, 156, and subcategories, and
for tumours of the pancreas (ICD-9 157), in England and Wales were
investigated from the Office for National Statistics, London, from 1968 to 1996 inclusive. Data for 1997 and 1998 were also available on
intrahepatic cholangiocarcinomas.
RESULTSThere has been
a marked rise in age standardised mortality rates for intrahepatic
cholangiocarcinoma. Since 1993, it represents the commonest recorded
cause of liver tumour related death in England and Wales. This is
evident in age groups older than 45 years. In contrast, mortality
trends from other primary liver tumours, including hepatocellular
carcinoma, were unremarkable.
CONCLUSIONSThe
observed increase in mortality from intrahepatic cholangiocarcinoma may
represent better case ascertainment and diagnosis due to improved
diagnostic imaging, use of image guided biopsies, or increased use of
ERCP. However, the trend started before ERCP was introduced nationally,
mortality rates have continued to increase steadily thereafter, and
there is no clear evidence that diagnostic transfers easily explains
the findings. Alternatively, these observations may represent a true
increase in intrahepatic bile duct tumours. Epidemiological studies
are required to determine whether there is any geographical clustering
of cases around the UK.
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