Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Department of Epidemiology and Biostatistics, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand.
Trop Med Int Health. 2024 May;29(5):390-404. doi: 10.1111/tmi.13983. Epub 2024 Mar 14.
Cholangiocarcinoma (CCA) caused by Opisthorchis viverrini is a well-known and significant public health issue in northeastern Thailand; however, a link between pesticide exposure (PE) and CCA risk has not yet been established. Therefore, our research objective was to investigate the relationship between PE and CCA risk.
A hospital-based matched case-control study was carried out. All cases (in-patients) and controls (out-patients) were volunteers at a tertiary hospital in northeast Thailand. Between 2015 and 2019, 178 incident cases of pathologically-confirmed CCA and 356 controls were selected from the check-up clinic from the Srinagarind Hospital outpatient database (two controls per case). The recruited controls were individually-matched to the CCA cases based on sex, age (±5 years) and admission date (±3 months). During face-to-face interviews, a standardised pre-tested questionnaire was used to collect data. Multivariable conditional logistic regression was used to analyse the data.
The respective frequency of PE between the 178 CCA cases and 356 controls was 77.0% versus 87.6% for never used, 14.6% versus 5.3% for have used but stopped and 8.4% versus 7.0% for currently using. After adjusting for the highest educational attainment, smoking behaviour, alcohol use and family history of cancer, PE was not significantly associated with CCA (p-value = 0.086). Using volunteers who have never used PE as the reference group, the respective odds of developing CCA for those who have ever used but have since stopped and are currently using was 2.04 (adjusted OR = 2.04; 95% CI: 1.03-4.04) versus 0.83 (adjusted OR = 0.83; 95% CI: 0.39-1.76) times more likely to develop CCA than those who had never used PE.
There is no association between PE and the risk of CCA. Notwithstanding the finding, future research should focus on enhancing PE assessment methods that consider complex chemical mixtures, chemicals of interest, historical exposure and exposure pathways. Moreover, there is need for more extensive and longer population-based cohort studies that include younger, non-occupationally exposed individuals during periods of developmental susceptibility.
华支睾吸虫引起的胆管癌是泰国东北部一个众所周知的重大公共卫生问题；然而，农药暴露（PE）与胆管癌风险之间的联系尚未建立。因此，我们的研究目的是调查 PE 与 CCA 风险之间的关系。
进行了一项基于医院的病例对照研究。所有病例（住院患者）和对照组（门诊患者）均为泰国东北部一家三级医院的志愿者。2015 年至 2019 年期间，从 Srinagarind 医院门诊数据库中选择了 178 例经病理证实的 CCA 新发病例和 356 例对照（每例 2 例对照）。招募的对照者根据性别、年龄（±5 岁）和入院日期（±3 个月）与 CCA 病例进行个体匹配。在面对面访谈中，使用标准化的预测试问卷收集数据。多变量条件逻辑回归用于分析数据。
178 例 CCA 病例和 356 例对照者中，PE 的使用频率分别为从未使用的 77.0%和 87.6%，有使用但已停用的 14.6%和 5.3%，以及当前使用的 8.4%和 7.0%。调整最高教育程度、吸烟行为、饮酒和癌症家族史后，PE 与 CCA 无显著相关性（p 值=0.086）。以从未使用过 PE 的志愿者作为参考组，曾使用但已停用且目前正在使用的人发生 CCA 的几率分别为从未使用过的 2.04 倍（调整 OR=2.04；95%CI：1.03-4.04）和 0.83 倍（调整 OR=0.83；95%CI：0.39-1.76）。
PE 与 CCA 风险之间没有关联。尽管有此发现，但未来的研究应侧重于增强 PE 评估方法，考虑复杂的化学混合物、关注的化学物质、历史暴露和暴露途径。此外，还需要进行更广泛和更长时间的基于人群的队列研究，包括在发育易感性期间非职业性暴露的年轻个体。
