Increased Risk of Hepatobiliary Cancers After Hospitalization for Autoimmune Disease
Increased Risk of Hepatobiliary Cancers After Hospitalization for Autoimmune Disease
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DOI：
10.1016/j.cgh.2013.11.007
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发表时间：
2014-06-01
影响因子：
12.6
通讯作者：
Hemminki, Kari
中科院分区：
文献类型：
--
作者：
Castro, Felipe A.;Liu, Xiangdong;Hemminki, Kari
背景与目的：一些自身免疫性疾病与肝癌风险增加有关。然而，在发展为不同亚型的肝胆癌的患者中，还没有对自身免疫性疾病的综合评估。我们研究了自身免疫性疾病和癌症的肝脏和胆道在Swedishpopulation.METHODS：我们分析了国家数据集在初级卫生保健研究中心（隆德大学，瑞典）之间的关联。从1964年至2008年的瑞典医院出院登记处检索了自身免疫性疾病患者的数据;对33种疾病进行了评价。从瑞典癌症登记处检索肝胆癌病例。我们计算了标准化发病率比（SIR）和风险比的发病率和死亡率从hepatobiliary cancer.RESULTS：在402,462例自身免疫性疾病，582例被诊断为原发性肝癌，330例胆囊癌，115例肝外胆管癌，43例壶腹癌。我们确定了14种与原发性肝癌风险增加显著相关的自身免疫性疾病（总体SIR [任何自身免疫性疾病]，2.1; 95%置信区间[CI]，2.0-2.3），5种与胆囊癌相关的疾病（总体SIR，1.3; 95% CI，1.1-1.4），3例与肝外胆管癌相关（总体SIR，1.6; 95% CI，1.3-1.9）。与原发性肝癌相关性最强的自身免疫性疾病是原发性胆汁性肝硬化（SIR，39.5; 95%CI，28.2-53.8）和自身免疫性肝炎（SIR，29.0; 95%CI，9.1-68.2）;溃疡性结肠炎与肝外胆管癌密切相关（SIR，5.6; 95%CI，3.6-8.4）。乳糜泻、克罗恩病、系统性硬化症和溃疡性结肠炎与至少2种癌症相关。增加的风险比，观察只有胆道癌患者谁已住院的自身免疫性conditions.CONCLUSIONS：在瑞典人口的研究中，我们确定了一个人诊断为自身免疫性疾病的肝胆癌的风险增加。不同癌症类型之间的关联表明，共同的免疫调节机制决定了对肝胆癌的易感性。
BACKGROUND & AIMS: Some autoimmune diseases are associated with increased risk of liver cancer. However, there has been no comprehensive evaluation of autoimmune diseases among patients who develop different subtypes of hepatobiliary cancer. We examined the association between autoimmune diseases and cancers of the liver and biliary tract in the Swedish population.METHODS: We analyzed data from national datasets at the Center for Primary Health Care Research (Lund University, Sweden). Data on patients with autoimmune disorders were retrieved from the Swedish Hospital Discharge Register, from 1964 through 2008; 33 diseases were evaluated. Hepatobiliary cancer cases were retrieved from the Swedish Cancer Registry. We calculated standardized incidence ratios (SIRs) and hazard ratios for incident cancers and deaths from hepatobiliary cancers.RESULTS: Among 402,462 patients with autoimmune disorders, 582 were diagnosed with primary liver cancer, 330 with gallbladder cancer, 115 with extrahepatic bile duct cancer, and 43 with ampulla of Vater cancers. We identified 14 autoimmune conditions that were significantly associated with increased risk of primary liver cancer (overall SIR [any autoimmune disease], 2.1; 95% confidence interval [CI], 2.0-2.3), 5 conditions associated with gallbladder cancer (overall SIR, 1.3; 95% CI, 1.1-1.4), and 3 associated with extrahepatic bile duct cancer (overall SIR, 1.6; 95% CI, 1.3-1.9). The autoimmune disorders with the strongest association with primary liver cancer were primary biliary cirrhosis (SIR, 39.5; 95% CI, 28.2-53.8) and autoimmune hepatitis (SIR, 29.0; 95% CI, 9.1-68.2); ulcerative colitis was strongly associated with extrahepatic bile duct cancer (SIR, 5.6; 95% CI, 3.6-8.4). Celiac disease, Crohn's disease, systemic sclerosis, and ulcerative colitis were associated with at least 2 types of cancer. Increased hazard ratios were observed only for patients with biliary tract cancer who had been hospitalized for autoimmune conditions.CONCLUSIONS: In a study of the Swedish population, we identified an increased risk of hepatobiliary cancers among individuals diagnosed with autoimmune disease. Associations among different cancer types indicate that shared immunomodulatory mechanisms determine susceptibility to hepatobiliary cancer.