Epidemiologic aspects of gallbladder cancer: A case-control study of the SEARCH Program of the International Agency for Research on Cancer
Epidemiologic aspects of gallbladder cancer: A case-control study of the SEARCH Program of the International Agency for Research on Cancer
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DOI：
10.1093/jnci/89.15.1132
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发表时间：
1997-08-06
影响因子：
10.3
通讯作者：
Walker, AM
中科院分区：
文献类型：
--
作者：
Zatonski, WA;Lowenfels, AB;Walker, AM
背景：以前对胆囊癌的流行病学研究很少，胆囊癌是一种罕见但几乎总是致命的胃肠道癌症，在成年女性和老年男女受试者以及整个中欧和东欧人群以及某些种族群体（如美洲原住民印第安人）中发病率较高。不幸的是，预防这种形式的癌症的前景很差。 目的：我们进行这项研究的目的是调查胆囊癌可能的新危险因素，并加强我们对可能参与这种疾病的已知致病因素的了解。方法：从 1983 年 1 月到 1988 年 7 月，在位于澳大利亚（阿德莱德）、加拿大（蒙特利尔和多伦多）、荷兰（乌得勒支）和波兰（奥波莱）的五个中心进行了一项大型、协作、多中心、胆囊癌病例对照研究。这些中心根据医院病理记录和向地区癌症登记处的报告收集了胆囊癌病例。胆囊切除术或尸检时，对照受试者从人群中随机分配到每个中心。汇总分析包括 196 名病例受试者和 1515 名对照受试者（未报告既往胆囊切除术）。百分之九十八的受试者是白人，对病例受试者、对照受试者和代理人（配偶或近亲）的个人访谈是由经过培训的人员进行的。结果：在调整了潜在的混杂因素（年龄、秒数、中心、访谈类型、受教育年限、饮酒量和终生吸烟）后，需要就医的胆囊症状史（例如，由于胆总管或胆囊管阻塞，胆囊分泌到小肠的胆汁减少）是与这种癌症相关的主要危险因素（比值比 [OR] = 4.4；95% 置信区间） [CI] = 2.6-7.5），即使在由于症状出现时间早于 20 Sears 之前而首次进行胆囊检查的受试者中也存在这种关联（OR = 6.2；95% CI = 2.8-13.4）。与胆囊癌风险相关的其他变量包括升高。体重指数、高总能量摄入、高碳水化合物摄入（调整总能量摄入后）和慢性腹泻。所有这些危险因素以前都与胆结石疾病有关。结论：这些发现与胆结石或胆结石危险因素在胆囊癌病因中的主要作用一致。关于是否需要筛查高危受试者胆结石或胆囊癌的更多信息。
Background: There are few previous epidemiologic studies of gallbladder cancer, a rare but nearly always lethal gastrointestinal cancer with a demonstrated greater frequency in adult women and older subjects of both sexes, and also in the members of populations throughout central and eastern Europe and certain racial groups such as native American Indians. Unfortunately, the prospects far the prevention of this form of cancer are poor, Purpose: Our purpose in conducting this study was to investigate possible new risk factors for gallbladder cancer and to strengthen our understanding of established causal agents that may he involved in this disease. Methods: A large, collaborative, multicenter, case-control study of cancer of the gallbladder was conducted in five centers located in Australia (Adelaide), Canada (Montreal and Toronto), The Netherlands (Utrecht), and Poland (Opole) from January 1983 through July 1988. Case subjects with gallbladder cancer were accrued by the centers from hospital pathology records and from reports to regional cancer registries, Cancer diagnosis was confirmed, by either biopsy, cholecystectomy, or at the time of autopsy, Control subjects were randomly assigned at each center from the population. The pooled analysis included 196 case subjects and 1515 control subjects (who did not report previous cholecystectomy). Ninety-eight percent of the subjects were white, Personal interviews of case subjects, control subjects, and surrogates (spouse or next of kin) were conducted by trained personnel. Results: After adjusting for potential confounding factors (age, sec., center, type of interview, years of schooling, alcohol intake, and lifetime cigarette smoking), a history of gallbladder symptoms requiring medical attention (e.g., reduced bile secretion from the gallbladder into the small intestine due to obstructions of the common bile or cystic ducts) was the major risk factor associated with this form of cancer (odds ratio [OR] = 4.4; 95% confidence interval [CI] = 2.6-7.5), This association was present even in subjects who had their first gallbladder examination because of symptoms present more than 20 Sears earlier (OR = 6.2; 95% CI = 2.8-13.4). Other variables associated with gallbladder cancer risk included an elevated. body mass index, high total energy intake, high carbohydrate intake (after adjustment for total energy intake), and chronic diarrhea. All of these risk factors have been previously associated with gallstone disease. Conclusions: These findings are consistent with a major role of gallstones, or risk factors for gallstones, in the cause of gallbladder cancer. Additional information on whether or not screening high-risk subjects for gallstones oi gallbladder cancer is needed.