Original Contribution
The American Journal of Gastroenterology (2007) 102, 1016–1021; doi:10.1111/j.1572-0241.2007.01104.x
Risk Factors for Intrahepatic and Extrahepatic Cholangiocarcinoma: A Hospital-Based Case–Control Study
Yasser H Shaib MD, MPH1, Hashem B El-Serag MD, MPH1, Ajay K Nooka MS2, Melanie Thomas MD2, Thomas D Brown MD2, Yehuda Z Patt MD3 and Manal M Hassan MD, PhD2
- 1Sections of Health Services Research and Gastroenterology at The Houston Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas
- 2Department of Gastrointestinal Medical Oncology, M.D. Anderson Cancer Center, Houston, Texas
- 3Section of Gastrointestinal Oncology at University of New Mexico Cancer Center, Albuquerque, New Mexico
Correspondence: Manal M Hassan, MD, PhD, MD, Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030.
Received 21 September 2006; Accepted 21 November 2006.
Abstract
BACKGROUND:
The risk factors for cholangiocarcinoma are poorly defined in the United States. We evaluated hepatitis C virus (HCV), hepatitis B virus (HBV), and liver cirrhosis as risk factors for intrahepatic cholangiocarcinoma (ICC) and extrahepatic cholangiocarcinoma (ECC).
METHODS:
A case–control study in which cases were cholangiocarcinoma patients referred to the M.D. Anderson Cancer Center between 1992 and 2002 and controls were healthy individuals. Information about liver diseases, family history, diabetes, smoking, and alcohol consumption were collected on both groups. Blood from all participants was tested for HBV and HCV markers.
RESULTS:
We identified 246 cases (83 ICC and 163 ECC) and matched them to 236 controls. Compared with controls, ICC patients had a higher prevalence of anti-HCV antibodies (6.0% vs 0.8%, P = 0.01), anti-HBc (9.6% vs 0%, P < 0.0001), and heavy alcohol consumption (21.7% vs 3.8%, P < 0.0001). The adjusted odds ratio and 95% confidence interval (CI) were 7.9 (95% CI 1.3–84.5), 28.6 (95% CI 3.9–1,268.1), and 5.9 (95% CI 2.1–17.4), respectively. Only heavy alcohol consumption was higher in patients with ECC than in controls (17.8% vs 3.8%, P = 0.003). The prevalence of diabetes and smoking were not significantly different between cases (ICC or ECC) and controls. The prevalence of cirrhosis was higher in patients with ICC than those with ECC (24.1% vs 4.9%, P < 0.0001).
CONCLUSIONS:
Liver cirrhosis and chronic HCV infection are possible risk factors for ICC but not ECC. Heavy alcohol consumption is a risk factor for both ICC and ECC.
