Gallstones and the Risk of Gallbladder Cancer Mortality: A Cohort Study
Gallstones and the Risk of Gallbladder Cancer Mortality: A Cohort Study
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DOI：
10.1038/ajg.2016.345
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发表时间：
2016-10-01
影响因子：
9.8
通讯作者：
Shin, Hocheol
中科院分区：
文献类型：
--
作者：
Ryu, Seungho;Chang, Yoosoo;Shin, Hocheol
目的：尽管有流行病学数据，但仍缺乏胆结石作为胆囊癌病因的明确证据。本研究的目的是在一项针对韩国男性和女性的大型研究中评估超声确定的胆结石与胆囊癌死亡风险之间的关联。此外，还调查了胆结石和胆囊切除术以及肝胆癌死亡风险之间的关系。 方法：对 2002 年至 2012 年接受健康检查的 396,720 名韩国男性和女性进行队列研究。使用 Cox 比例风险回归分析估计死亡结果的风险比。生命状况和死因分配基于与死亡证明记录的国家死亡指数的联系。 结果：在总共 2,158,906.2 人年的随访中（中位随访时间为 5.4 年），我们确定了 224 例肝胆癌死亡病例，其中 174 例为肝癌/肝内胆管癌，20 例为胆囊癌，30 例为胆囊癌。胆道癌。胆结石与肝胆癌死亡率（尤其是肝癌/肝内胆管癌）和胆囊癌死亡率增加的风险显着相关。比较患有胆结石的受试者与未患胆结石的受试者，肝胆癌、肝癌/肝内胆管癌和胆囊癌死亡率的多变量调整风险比（95%置信区间）分别为2.74（1.83-4.10）、2.34（1.45-3.77）和7.35（2.60-20.8）。胆囊切除术与肝胆癌死亡率没有显着相关性。结论：在这项大型队列研究中，胆结石与肝胆癌死亡率（尤其是肝癌/肝内癌）和胆囊癌死亡率增加的风险相关，与潜在的混杂因素无关。未来的研究需要更长的随访时间，其中包括癌症病例的数据，应该可以更全面地了解胆结石在癌症发展中的作用。
OBJECTIVES: Despite epidemiologic data, definitive evidence for the role of gallstones as a cause for gallbladder cancer is lacking. The goal of this study was to evaluate the association between gallstones, determined by ultrasound, and the risk of gallbladder cancer mortality in a large study of Korean men and women. In addition, the association between gallstones and cholecystectomy, and risk of hepatobiliary cancer mortality was investigated.METHODS: A cohort study was performed for 396,720 South Korean men and women who underwent a health checkup from 2002 to 2012. Hazard ratios for mortality outcomes were estimated using Cox-proportional hazards regression analysis. Vital status and cause of death assignment were based on linkage to the National Death Index of death certificate records.RESULTS: From a total of 2,158,906.2 person-years of follow-up (median follow-up of 5.4 years), we identified 224 deaths from hepatobiliary cancer, comprising 174 cases of liver/intrahepatic bile ducts cancer, 20 cases of gallbladder cancer, and 30 cases of biliary tract cancer. Gallstones were significantly associated with increased risk of hepatobiliary cancer mortality, especially liver/intrahepatic biliary cancer, and gallbladder cancer mortality. The multivariable-adjusted hazard ratios (95% confidence intervals) for hepatobiliary cancer, liver/intrahepatic biliary cancer, and gallbladder cancer mortality comparing subjects having gallstones with those without gallstone disease were 2.74 (1.83-4.10), 2.34 (1.45-3.77), and 7.35 (2.60-20.8), respectively. Cholecystectomy was not significantly associated with hepatobiliary cancer mortality.CONCLUSIONS: In this large cohort study, gallstones were associated with increased risk of hepatobiliary cancer mortality, especially liver/intrahepatic cancer, and gallbladder cancer mortality independent of potential confounders. Future studies with longer follow-up periods that include data on incident cancer cases should provide a more comprehensive view of the role of gallstones in cancer development.