Cancer Res Treat.  2017 Jan;49(1):54-60. 10.4143/crt.2016.045.

Estimation of the Incidence of Hepatocellular Carcinoma and Cholangiocarcinoma in Songkhla, Thailand, 1989-2013, Using Multiple Imputation Method

• Yeesoonsang S
• Bilheem S
• McNeil E
• Iamsirithaworn S
• Jiraphongsa C
• Sriplung H

• KMID: 2367503
• DOI: http://doi.org/10.4143/crt.2016.045

Abstract

PURPOSE
Histological specimens are not required for diagnosis of liver and bile duct (LBD) cancer, resulting in a high percentage of unknown histologies. We compared estimates of hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA) incidences by imputing these unknown histologies.
MATERIALS AND METHODS
A retrospective study was conducted using data from the Songkhla Cancer Registry, southern Thailand, from 1989 to 2013. Multivariate imputation by chained equations (mice) was used in re-classification of the unknown histologies. Age-standardized rates (ASR) of HCC and CCA by sex were calculated and the trends were compared.
RESULTS
Of 2,387 LBD cases, 61% had unknown histology. After imputation, the ASR of HCC in males during 1989 to 2007 increased from 4 to 10 per 100,000 and then decreased after 2007. The ASR of CCA increased from 2 to 5.5 per 100,000, and the ASR of HCC in females decreased from 1.5 in 2009 to 1.3 in 2013 and that of CCA increased from less than 1 to 1.9 per 100,000 by 2013. Results of complete case analysis showed somewhat similar, although less dramatic, trends.
CONCLUSION
In Songkhla, the incidence of CCA appears to be stable after increasing for 20 years whereas the incidence of HCC is now declining. The decline in incidence of HCC among males since 2007 is probably due to implementation of the hepatitis B virus vaccine in the 1990s. The rise in incidence of CCA is a concern and highlights the need for case control studies to elucidate the risk factors.

Keyword

Hepatocellular carcinoma; Cholangiocarcinoma; Thailand; Incidence; Estimation techniques

MeSH Terms

Bile Ducts
Carcinoma, Hepatocellular*
Case-Control Studies
Cholangiocarcinoma*
Diagnosis
Female
Hepatitis B virus
Humans
Incidence*
Liver
Male
Methods*
Retrospective Studies
Risk Factors
Statistics as Topic
Thailand*

Figure

• 

  Fig. 1. Percentage of histologic tpyes of liver and bile duct cancer in both sexes by calendar year. The percentage of cases with unknown histologic type (orange line) increased from around 40% in 1999 to 70% in 2005 and then plateaued. The percentage of hepatocellular carcinoma (blue line) decreased rapidly in 2000 and then showed a steady decline.

• 

  Fig. 2. The percentage of cases with morphologic verification (% MV; basis of diagnosis code, 5-8) and the percentage of cases with imaging verification (% IV; basis of diagnosis code, 2-8) by calendar year. The pathological diagnosis declined from 1998 to 2005 and then plateaued while the use of imaging in diagnosis of liver and bile duct cancer increased from 1989 through around 2000 and then plateaued at around 90%.

• 

  Fig. 3. Age standardized incidence rates (ASR) of liver and bile duct (LBD) cancers in Songkhla from 1989 to 2013 for the two major histologic categories; hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA), stratified by sex. Model 1, complete-case analysis; model 2, multiple imputation (MI) with LBD cancers with unknown histology only; model 3, MI of LBD cancers with unknown histology combined with cancer of unknown primary in the abdomen (C76.2) and unknown primary site, not otherwise specified (C80.9).

Reference

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