Menon Shyam, Mathew Ray
The Royal Wolverhampton NHS Trust, Wolverhampton, UK.
Indian J Gastroenterol. 2019 Feb;38(1):61-68. doi: 10.1007/s12664-018-0925-y. Epub 2019 Jan 10.
The incidence of hepatobiliary cancer is steadily increasing. It is unclear if this rise is related to increasing trends in obesity, metabolic syndrome, and lifestyle changes.
A case-control study was performed using the Health Improvement Network (THIN) database. Cases with a diagnosis of liver, bile duct, and gallbladder cancers were matched in a 1:2 fashion with controls and analyzed for potential associations between hepatobiliary cancer and obesity/metabolic syndrome.
Four thousand two hundred and eighty-seven patients (62% male, 38% female) with hepatobiliary cancers were matched with 8574 controls. On univariate analysis, body mass index (BMI), smoking, diabetes, alcohol consumption, ischemic heart disease, and hypertension were associated with hepatobiliary cancer. Statin use and non-smoking status had an inverse association. On multivariate analysis, BMI, diabetes, hypertension, ischemic heart disease, and insulin use were associated with the risk of hepatobiliary cancer. Statin use and non-smoking status were protective. On modeling BMI, each of diabetes and hypertension as a single covariate, there was a significant association with hepatobiliary cancer (1.59 [1.49-1.69], p < 0.001) which persisted despite adjusting for increasing age (1.006 [1005-1.006], p < 0.001) and background liver cirrhosis (1.037 [1.03-1.044], p < 0.001).
Obesity and metabolic syndrome are associated with the risk of hepatobiliary cancer. Statin use seems to be protective.
肝胆癌的发病率正在稳步上升。目前尚不清楚这种上升是否与肥胖、代谢综合征和生活方式变化的增加趋势有关。
使用健康改善网络（THIN）数据库进行了一项病例对照研究。将诊断为肝癌、胆管癌和胆囊癌的病例与对照以1:2的比例进行匹配，并分析肝胆癌与肥胖/代谢综合征之间的潜在关联。
4287例（62%为男性，38%为女性）肝胆癌患者与8574例对照进行了匹配。单因素分析显示，体重指数（BMI）、吸烟、糖尿病、饮酒、缺血性心脏病和高血压与肝胆癌有关。使用他汀类药物和非吸烟状态呈负相关。多因素分析显示，BMI、糖尿病、高血压、缺血性心脏病和使用胰岛素与肝胆癌风险有关。使用他汀类药物和非吸烟状态具有保护作用。在将BMI、糖尿病和高血压分别作为单一协变量进行建模时，与肝胆癌存在显著关联（1.59[1.49 - 1.69]，p < 0.001），尽管在调整年龄增长（1.006[1.005 - 1.006]，p < 0.001）和背景肝硬化（1.037[1.03 - 1.044]，p < 0.001）后该关联仍然存在。
肥胖和代谢综合征与肝胆癌风险相关。使用他汀类药物似乎具有保护作用。
