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Hepatitis B virus infection, diabetes mellitus, and their synergism for cholangiocarcinoma development: a case-control study in Korea

 Ban Seok Lee  ;  Eun-Cheol Park  ;  Seung Woo Park  ;  Chung Mo Nam  ;  Jaehoon Roh 
 WORLD JOURNAL OF GASTROENTEROLOGY, Vol.21(2) : 502-510, 2015 
Journal Title
Issue Date
Aged ; Aged, 80 and over ; Bile Duct Neoplasms/diagnosis ; Bile Duct Neoplasms/epidemiology* ; Bile Ducts, Intrahepatic ; Case-Control Studies ; Chi-Square Distribution ; Cholangiocarcinoma/diagnosis ; Cholangiocarcinoma/epidemiology* ; Diabetes Mellitus, Type 1/diagnosis ; Diabetes Mellitus, Type 1/epidemiology* ; Diabetes Mellitus, Type 2/diagnosis ; Diabetes Mellitus, Type 2/epidemiology* ; Female ; Hepatitis B/diagnosis ; Hepatitis B/epidemiology* ; Humans ; Logistic Models ; Male ; Middle Aged ; Odds Ratio ; Republic of Korea/epidemiology ; Risk Assessment ; Risk Factors
Cholangiocarcinoma ; Diabetes mellitus ; Hepatitis ; Risk factor ; Synergism
AIM: To identify possible risk factors and their synergism for cholangiocarcinoma development.
METHODS: A hospital-based, case-control study in which we included 276 cholangiocarcinoma patients [193 extrahepatic cholangiocarcinoma (ECC) and 83 intrahepatic cholangiocarcinoma (ICC)], diagnosed at a training hospital in Korea between 2007 and 2013, and 552 healthy controls matched 2:1 for age, sex, and date of diagnosis. Risk factors for cholangiocarcinoma and possible synergism between those factors were evaluated using conditional logistic regression and synergism index, respectively.
RESULTS: There was an association between cholangiocarcinoma and hepatitis B virus (HBV) infection, diabetes mellitus (DM), cholecystolithiasis, choledocholithiasis, and hepatolithiasis, with the adjusted odds ratios (AORs) of 4.1, 2.6, 1.7, 12.4, and 39.9, respectively. Synergistic interaction on the additive model was investigated between HBV infection and DM (AOR = 12.2; 95%CI: 1.9-80.1). In the subgroup analyses, cholecystolithiasis, choledocholithiasis, hepatolithiasis, and DM were significant risk factors for ECC (AOR = 2.0, 18.1, 14.9, and 2.0, respectively), whereas choledocholithiasis, hepatolithiasis, HBV infection, and DM were risk factors for ICC (AOR = 8.6, 157.4, 5.3 and 4.9, respectively). Synergistic interaction was also observed between HBV infection and DM (OR = 22.7; 95%CI: 2.4-214.1). However, there was no synergistic interaction between other significant risk factors for cholangiocarcinoma.
CONCLUSION: In this Korean study, HBV infection and DM were found to exert independent and synergistic effects on the risk for cholangiocarcinoma, including ICC. Exploring the underlying mechanisms for such synergy may lead to the development of cholangiocarcinoma prevention strategies in high-risk individuals.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Preventive Medicine (예방의학교실) > 1. Journal Papers
Yonsei Authors
Nam, Chung Mo(남정모) ORCID logo https://orcid.org/0000-0003-0985-0928
Roh, Jae Hoon(노재훈)
Park, Seung Woo(박승우) ORCID logo https://orcid.org/0000-0001-8230-964X
Park, Eun-Cheol(박은철) ORCID logo https://orcid.org/0000-0002-2306-5398
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