美国肝内胆管癌的危险因素：一项病例对照研究。

Risk factors of intrahepatic cholangiocarcinoma in the United States: a case-control study.

作者信息

Shaib Yasser H, El-Serag Hashem B, Davila Jessica A, Morgan Robert, McGlynn Katherine A

机构信息

Section of Health Services Research, Michael E. Debakey Veterans Affairs Medical Center, Baylor College of Medicine, Houston, Texas 77030, USA.

出版信息

Gastroenterology. 2005 Mar;128(3):620-6. doi: 10.1053/j.gastro.2004.12.048.

DOI:10.1053/j.gastro.2004.12.048

PMID:15765398

Abstract

BACKGROUND & AIMS: The incidence of intrahepatic cholangiocarcinoma has been recently increasing in the United States. In this case-control study, we used the Surveillance, Epidemiology, and End Results-Medicare database to evaluate the prevalence of known risk factors for intrahepatic cholangiocarcinoma and explore other potential risk factors.

METHODS

We identified all patients with intrahepatic cholangiocarcinoma aged 65 years and older diagnosed between 1993 and 1999 in the population-based Surveillance, Epidemiology, and End Results registries (14% of the US population). Controls were randomly chosen from individuals without any cancer diagnosis in the underlying population of the Surveillance, Epidemiology, and End Results regions. We obtained information on risk factors from Medicare claims (parts A and B) for all cases and controls with at least 2 years of continuous Medicare enrollment. Unadjusted and adjusted odds ratios were calculated in logistic regression analysis.

RESULTS

A total of 625 cases and 90,834 controls satisfied the inclusion and exclusion criteria. Cases were older than controls (78.7 vs. 76.5 years; P=.02) and were more likely to be male (48.3% vs. 36.8%; P <.0001). The racial composition was similar between cases and controls. Several risk factors were significantly more prevalent among cases. These included nonspecific cirrhosis (adjusted odds ratio, 27.2; P <.0001), alcoholic liver disease (adjusted odds ratio, 7.4; P <.0001), hepatitis C virus infection (adjusted odds ratio, 6.1; P <.0001), human immunodeficiency virus infection (adjusted odds ratio, 5.9; P=.003), diabetes (adjusted odds ratio, 2.0; P <.0001), and inflammatory bowel diseases (adjusted odds ratio, 2.3; P=.002).

CONCLUSIONS

This population-based study shows that in addition to previously well described risk factors, several others could be associated with intrahepatic cholangiocarcinoma. These include hepatitis C virus, human immunodeficiency virus, liver cirrhosis, and diabetes.

摘要

背景与目的

美国肝内胆管癌的发病率近来呈上升趋势。在这项病例对照研究中，我们利用监测、流行病学与最终结果-医疗保险数据库来评估肝内胆管癌已知危险因素的流行情况，并探索其他潜在危险因素。

方法

我们在基于人群的监测、流行病学与最终结果登记处（覆盖美国14%的人口）中，确定了1993年至1999年间诊断出的所有65岁及以上的肝内胆管癌患者。对照组是从监测、流行病学与最终结果地区的基础人群中未被诊断出患有任何癌症的个体中随机选取的。我们从医疗保险理赔（A部分和B部分）中获取了所有至少连续参保医疗保险2年的病例和对照的危险因素信息。在逻辑回归分析中计算未调整和调整后的比值比。

结果

共有625例病例和90,834例对照符合纳入和排除标准。病例比对照年龄更大（78.7岁对76.5岁；P = 0.02），且更可能为男性（48.3%对36.8%；P < 0.0001）。病例和对照的种族构成相似。几个危险因素在病例中明显更为普遍。这些包括非特异性肝硬化（调整后的比值比，27.2；P < 0.0001）、酒精性肝病（调整后的比值比，7.4；P < 0.0001）、丙型肝炎病毒感染（调整后的比值比，6.1；P < 0.0001）、人类免疫缺陷病毒感染（调整后的比值比，5.9；P = 0.003）、糖尿病（调整后的比值比，2.0；P < 0.0001）和炎症性肠病（调整后的比值比，2.3；P = 0.002）。