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, 323 00 Pilsen, Czech Republic.
Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, 69120 Heidelberg, Germany.
Cancers (Basel). 2023 Jun 7;15(12):3092. doi: 10.3390/cancers15123092.
We aim to estimate population-attributable fractions (PAF) for 13 comorbidities potentially predisposing to hepatobiliary cancer of hepatocellular carcinoma (HCC), gallbladder cancer (GBC), cancers of the intrahepatic and extrahepatic bile ducts (ICC and ECC), and ampullary cancer.
Patients were identified from the Swedish Inpatient Register from 1987 to 2018 and cancers from the Swedish Cancer Registry from 1997 through 2018. PAFs were calculated for each comorbidity-associated cancer using a cohort study design.
For male HCC, the major individual comorbidities (PAF > 10) were diabetes, alcohol-related liver disease, and hepatitis C virus infection. For female HCC, diabetes and autoimmune diseases were important contributors. For female GBC, gallstone disease was an overwhelming contributor, with a PAF of 30.57%, which was also important for men. The overall PAF for male ICC was almost two times higher than the female one. For ECC and ampullary cancer, infection of bile ducts was associated with the highest PAF.
The 13 comorbidities accounted for 50% or more of the potential etiological pathways of each hepatobiliary cancer except female ICC. The underlying convergent mechanism for these cancers may be chronic inflammation lasting for decades and thus offering possibilities for intervention and disease monitoring.
我们旨在估算13种共病的人群归因分数（PAF），这些共病可能易引发肝细胞癌（HCC）、胆囊癌（GBC）、肝内和肝外胆管癌（ICC和ECC）以及壶腹癌等肝胆系统癌症。
从1987年至2018年的瑞典住院患者登记册中识别患者，并从1997年至2018年的瑞典癌症登记册中识别癌症病例。使用队列研究设计计算每种与共病相关癌症的PAF。
对于男性HCC，主要的个体共病（PAF>10）为糖尿病、酒精性肝病和丙型肝炎病毒感染。对于女性HCC，糖尿病和自身免疫性疾病是重要因素。对于女性GBC，胆结石病是主要因素，PAF为30.57%，对男性也很重要。男性ICC的总体PAF几乎是女性的两倍。对于ECC和壶腹癌，胆管感染与最高的PAF相关。
除女性ICC外，这13种共病占每种肝胆系统癌症潜在病因途径的50%或更多。这些癌症潜在的共同机制可能是持续数十年的慢性炎症，从而为干预和疾病监测提供了可能。
