P-109 Global mortality for biliary tract cancer

Biliary Tract Cancer (BTC) represents a high disease burden due to late diagnosis, poor prognosis, and limited treatment options. Current knowledge is limited regarding the global mortality of various subtypes of BTC and how that may have changed during the past decade. BTC mortality was evaluated using the latest World Health Organization (WHO) Mortality Database. Mortality was examined in patients ≥20 years who were diagnosed with BTC as identified by ICD-10 and evaluated by subtype (extrahepatic cholangiocarcinoma [ECC], intrahepatic cholangiocarcinoma [ICC], gall bladder cancer [GBC], and ampulla of Vater cancer [AVC]), gender, geography, and age. Data are reported for selected countries that had ≥5 years of data on both patients with BTC and their total populations between 2006 and 2016. Age-standardized mortality rates (ASR; per 100,000 person-years) with standard error (SE) were calculated using the latest world standard population. Temporal trends of total BTC were described and estimates of average annual percent change (AAPC) were calculated for each country. There were 39 Asia-Pacific and European countries with data that met the criteria; of those, the highest mortality rate for BTC overall was observed for patients in the Republic of Korea, both < 75 and ≥75 years (ASR=12.99 and ASR=130.00, respectively). The lowest mortality rate was in Georgia and Kyrgyzstan for patients < 75 years (ASR=2.07) and in the Republic of Moldova for patients ≥75 years (ASR=9.27). An assessment of regional differences in the UK revealed that patients in Northern Ireland and Scotland had higher mortality rates than patients in England and Wales. As is typical of most cancers, elderly patients had a higher mortality rate than younger patients: the highest relative mortality rate (RMR; reference < 75 years) between the 2 age groups was in Japan (20.43) and the lowest RMR was in Kyrgyzstan (6.61). Mortality rates increased overtime for 25 out of 39 countries. The highest increase in mortality was seen in Lithuania (AAPC=4.65%). Of the BTC subtypes, ICC showed the highest mortality in 26 countries, GBC in 12 countries, and ECC had the highest mortality rate in Japan. Mortality rates for most subtypes were evenly distributed between sexes or were higher for males in some cases, but GBC mortality rates were higher in females in most countries. Though a relatively rare diagnosis in many countries, the mortality rate of BTC is high and is exponentially higher in elderly patients. Higher BTC mortality rates coincide with previously reported higher incidence in certain geographic areas, particularly in Japan. These reported mortality rates and the overall increases in mortality rates make it clear that a high unmet need remains for improved treatment for BTC.