Hemminki Kari, Sundquist Kristina, Sundquist Jan, Försti Asta, Liska Vaclav, Hemminki Akseli, Li Xinjun
Biomedical Center, Faculty of Medicine and Biomedical Center in Pilsen, Charles University in Prague, Pilsen, Czech Republic.
Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
Cancer. 2023 Jan 30. doi: 10.1002/cncr.34663.
Autoimmune diseases are associated with many cancers but there is a lack of population-based studies with different autoimmune diseases that have a long follow-up. This is also true of hepatobiliary cancers, which include hepatocellular cancer (HCC) and rarer entities of gallbladder cancer (GBC), intra- and extrahepatic cholangiocarcinoma (iCCA and eCCA), and ampullary cancer.
Diagnostic data on 43 autoimmune diseases were collected from the Swedish Inpatient Register from 1987 to 2018, and cancer data were derived from the national cancer registry from 1997 onward. Relative risks were expressed as standardized incidence ratios (SIRs).
In a population of 13.6 million, 1.1 million autoimmune diseases were diagnosed and subsequent hepatobiliary cancer was diagnosed in 3191 patients (17.2% of cancers). SIRs for HCC were 2.73 (men) and 2.86 (women), 3.74/1.96 for iCCA, 2.65/1.37 for GBC, 2.38/1.64 for eCCA, and 1.80/1.85 for ampullary cancer. Significant associations between autoimmune disease and HCC were observed for 13 autoimmune diseases, with the highest risks being for autoimmune hepatitis (48.92/73.53, men/women) and primary biliary cirrhosis (38.03/54.48). GBC was increased after six autoimmune diseases, with high SIRs for ulcerative colitis (12.22/3.24) and men with Crohn disease (9.16). These autoimmune diseases were also associated with a high risk of iCCA, which had seven other associations, and eCCA, which had five other associations. Ampullary cancer occurrence was increased after four autoimmune diseases.
An autoimmune disease is a common precursor condition for hepatobiliary cancers. This calls for careful control of autoimmune disease symptoms in each patient and encouragement to practice a healthy lifestyle.
自身免疫性疾病与多种癌症相关，但缺乏针对不同自身免疫性疾病且随访时间长的基于人群的研究。肝胆癌也是如此，其中包括肝细胞癌（HCC）以及胆囊癌（GBC）、肝内和肝外胆管癌（iCCA和eCCA）、壶腹癌等罕见实体肿瘤。
从瑞典住院患者登记处收集了1987年至2018年期间43种自身免疫性疾病的诊断数据，并从1997年起从国家癌症登记处获取癌症数据。相对风险以标准化发病率比（SIRs）表示。
在1360万人口中，诊断出110万例自身免疫性疾病，随后3191例患者被诊断出患有肝胆癌（占癌症患者的17.2%）。HCC的SIRs男性为2.73，女性为2.86；iCCA为3.74/1.96；GBC为2.65/1.37；eCCA为2.38/1.64；壶腹癌为1.80/1.85。观察到13种自身免疫性疾病与HCC之间存在显著关联，风险最高的是自身免疫性肝炎（男性/女性为48.92/73.53）和原发性胆汁性肝硬化（38.03/54.48）。六种自身免疫性疾病后GBC发病率增加，溃疡性结肠炎（12.22/3.24）和克罗恩病男性患者（9.16）的SIRs较高。这些自身免疫性疾病还与iCCA的高风险相关，iCCA还有其他七种关联，与eCCA的高风险相关，eCCA还有其他五种关联。四种自身免疫性疾病后壶腹癌发生率增加。
自身免疫性疾病是肝胆癌常见的前驱病症。这就要求对每位患者的自身免疫性疾病症状进行仔细控制，并鼓励他们保持健康的生活方式。
