Welzel Tania M, Graubard Barry I, El-Serag Hashem B, Shaib Yasser H, Hsing Ann W, Davila Jessica A, McGlynn Katherine A
Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA.
Clin Gastroenterol Hepatol. 2007 Oct;5(10):1221-8. doi: 10.1016/j.cgh.2007.05.020. Epub 2007 Aug 6.
BACKGROUND & AIMS: Intrahepatic and extrahepatic cholangiocarcinomas are rare and highly malignant cancers of the bile duct. Although the incidence of extrahepatic cholangiocarcinoma (ECC) has remained constant, the incidence of intrahepatic cholangiocarcinoma (ICC) has increased in the United States. Because the etiology of both tumors is poorly understood, a population-based case-control study was conducted to examine the association of ECC and ICC with preexisting medical conditions.
Medical conditions among 535 ICC patients, 549 ECC patients (diagnosed 1993-1999), and 102,782 cancer-free controls were identified by using the Surveillance, Epidemiology and End Results-Medicare databases. Logistic regression analysis was used to calculate adjusted odds ratios.
In addition to established risk factors (choledochal cysts, cholangitis, inflammatory bowel disease), several other conditions were significantly associated with ECC and ICC: biliary cirrhosis (ECC, ICC: P < .001), cholelithiasis (ECC, ICC: P < .001), alcoholic liver disease (ECC, P < .001; ICC, P = .01), nonspecific cirrhosis (ECC, ICC: P < .001), diabetes (ECC, ICC: P < .001), thyrotoxicosis (ECC, P = .006; ICC, P = .04), and chronic pancreatitis (ECC, ICC: P < .001). Conditions only associated with ICC were obesity (ECC, P = .71; ICC, P = .01), chronic nonalcoholic liver disease (ECC, P = .08; ICC, P = .02), HCV infection (ECC, P = .67; ICC, P = .01), and smoking (ECC, P = .07; ICC, P = .04).
Several novel associations with ECC and ICC were identified. HCV infection, chronic nonalcoholic liver disease, and obesity, all of which are increasing in incidence, and smoking were associated only with ICC, suggesting that these conditions might explain the divergent incidence trends of the tumors.
肝内胆管癌和肝外胆管癌是罕见且恶性程度高的胆管癌。尽管肝外胆管癌（ECC）的发病率保持稳定，但在美国肝内胆管癌（ICC）的发病率有所上升。由于这两种肿瘤的病因了解甚少，因此开展了一项基于人群的病例对照研究，以探讨ECC和ICC与既往疾病的关联。
利用监测、流行病学与最终结果-医疗保险数据库，确定了535例ICC患者、549例ECC患者（1993 - 1999年确诊）和102,782例无癌对照者的疾病情况。采用逻辑回归分析计算调整后的比值比。
除了已确定的危险因素（胆总管囊肿、胆管炎、炎症性肠病）外，其他几种疾病也与ECC和ICC显著相关：胆汁性肝硬化（ECC、ICC：P < 0.001）、胆石症（ECC、ICC：P < 0.001）、酒精性肝病（ECC，P < 0.001；ICC，P = 0.01）、非特异性肝硬化（ECC、ICC：P < 0.001）、糖尿病（ECC、ICC：P < 0.001）、甲状腺毒症（ECC，P = 0.006；ICC，P = 0.04）和慢性胰腺炎（ECC、ICC：P < 0.001）。仅与ICC相关的疾病有肥胖（ECC，P = 0.71；ICC，P = 0.01）、慢性非酒精性肝病（ECC，P = 0.08；ICC，P = 0.02）、丙型肝炎病毒感染（ECC，P = 0.67；ICC，P = 0.01）和吸烟（ECC，P = 0.07；ICC，P = 0.04）。
确定了几种与ECC和ICC的新关联。丙型肝炎病毒感染、慢性非酒精性肝病和肥胖的发病率均在上升，且吸烟仅与ICC相关，这表明这些情况可能解释了这两种肿瘤不同的发病率趋势。
