Dutta Usha, Bush Nikhil, Kalsi Dimple, Popli Priyanka, Kapoor Vinay K
Department of Gastroenterology, Post-graduate Institute of Medical Education and Research (PGIMER), Chandigarh India.
Department of Surgical Gastroenterology, Sanjay Gandhi Post-graduate Institute of Medical Sciences (SGPGIMS), Lucknow, India.
Chin Clin Oncol. 2019 Aug;8(4):33. doi: 10.21037/cco.2019.08.03.
India is a high incidence area for gallbladder cancer (GBC) and contributes to about 10% of the global GBC burden. Within India, the incidence is high in North, North-East, Central and Eastern India, and less common in South and West India. The incidence has been on a steady rise in both genders. The presentation is often with advanced disease and carries dismal prognosis. GBC in India usually affects younger patients in the 5th and 6th decade in contrast to the west. Gallstones are present in 80% of the Indian patients with GBC and its presence increases the vulnerability of the GB to mucosal injury. The incidence of GBC is out of proportion to the prevalence of gallstones in the country. Additional co-factors such as older age, lower socio-economic status, chronic Salmonella typhi (S. typhi) infection, Helicobacter pylori (H. pylori) infection, exposure to pollutants, heavy metals, chemicals, adulterated mustard oil and smoking in patients with gallstones have been identified which promote carcinogenesis. These risk factors act in tandem in an additive manner resulting in higher incidence of GBC as well as hasten the development of GBC. Environmental risk factors such as soil and water contamination by industrial wastes, agricultural effluents and human sewage have been identified as putative risk factors. Combination of a toxic environment, vulnerable GB and a susceptible host play a key role in the pathogenesis of GBC in the country. Large multicentric comprehensive studies are required in India to assess the attributable risk of each of the identified putative risk factors. This will help in formulating cost effective national strategies in preventing GBC related mortality in the country. Meanwhile a high index of suspicion to pick up incidental GBC, and improved access to healthcare facilities to manage GS appropriately will help in reducing GBC related mortality.
印度是胆囊癌（GBC）的高发地区，约占全球胆囊癌负担的10%。在印度国内，北部、东北部、中部和东部地区的发病率较高，而南部和西部地区则较为少见。男女发病率均呈稳步上升趋势。胆囊癌的临床表现通常为晚期疾病，预后不佳。与西方相比，印度的胆囊癌通常影响50多岁和60多岁的年轻患者。80%的印度胆囊癌患者伴有胆结石，胆结石的存在增加了胆囊黏膜损伤的易感性。胆囊癌的发病率与该国胆结石的患病率不相称。已确定其他协同因素，如年龄较大、社会经济地位较低、慢性伤寒沙门氏菌（伤寒杆菌）感染、幽门螺杆菌（幽门螺旋杆菌）感染、接触污染物、重金属、化学物质、掺假芥子油以及胆结石患者吸烟等，这些因素会促进癌症发生。这些风险因素协同作用，以累加的方式导致胆囊癌发病率更高，并加速胆囊癌的发展。已确定土壤和水受到工业废物、农业废水和生活污水污染等环境风险因素为假定风险因素。有毒环境、易损胆囊和易感宿主的组合在该国胆囊癌的发病机制中起关键作用。印度需要开展大型多中心综合研究，以评估每种已确定的假定风险因素的可归因风险。这将有助于制定具有成本效益的国家战略，预防该国与胆囊癌相关的死亡率。与此同时，提高对偶然发现的胆囊癌的怀疑指数，以及改善获得医疗保健设施以适当管理胆结石的机会，将有助于降低与胆囊癌相关的死亡率。
