Trends in incidence of primary liver cancer subtypes before and after the implementation of ICD-10, England 1990-2008


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J. Konfortion1, V. Coupland1, H. Kocher2, W. Allum3, D. Berry4, R. Jack1
1King's College London, London, UK, 2Barts Cancer Institute, London, UK, 3Royal Marsden Hospital, London, UK, 4University Hospital Wales, Cardiff, UK

Background

The aim of this study was to examine trends in incidence of primary liver cancer subtypes in England before and after the implementation of International Classification of Diseases 10th revision (ICD-10).

Method

Data was extracted for 23,119 male and 14,393 female patients diagnosed with primary liver cancer in England between 1990 and 2008 from the National Cancer Data Repository. Subtypes were defined by four digit ICD-10 codes: C22.0 hepatocellular carcinoma, C22.1 intrahepatic bile duct carcinoma, C22.2 hepatoblastoma, C22.3 angiosarcoma of liver, C22.4 other sarcomas of liver, C22.7 other specified carcinomas of liver and C22.9 unspecified malignant neoplasm of the liver. Male and female age-standardised incidence rates per 100,000 European standard population were calculated for each year. Average annual percentage changes (APC) were calculated for the years before and after implementation of ICD-10 (period 1: 1990-1994 and period 2: 1995-2008).

Results

Incidence of hepatocellular carcinoma increased in men from 0.89 per 100,000 in 1990 to 3.38 in 2008. The APCs were 6.9% for period 1 and 5.8% for period 2. In women the incidence was stable at around 0.25 per 100,000 in period 1 and increased to 0.76 (APC 3.5%) during period 2. Intrahepatic bile duct carcinoma incidence increased throughout the whole study period from 0.58 per 100,000 to 1.83 in men and 0.42 to 1.45 in women. The APCs were similar in men and women, approximately 9% in the first period and 5% for the second. Incidence of unspecified malignant neoplasm of the liver decreased from an average of 0.79 per 100,000 to 0.45 during the study period, and the remaining subtypes were stable at less than 0.25 per 100,000.

Conclusion

Hepatocellular carcinoma and intrahepatic bile duct carcinoma incidence increased between 1990 and 2008 in both sexes and appears to be a true increase with negligible influence from the ICD changeover in 1994.