Interactive role of diabetes mellitus and female sex in the risk of cholangiocarcinoma: A population-based nested case-control study

Abstract

Diabetes mellitus (DM) has been associated with an increased risk of extrahepatic cholangiocarcinoma (ECC) and intrahepatic cholangiocarcinoma (ICC). However, the role of DM in a population with a lower incidence of ECC remains unclear. We investigated the role of DM and other risk factors for ECC and ICC by conducting a population-based, nested, case–control study in Taiwan, a region with a lower incidence but a higher proportion of ICC. We identified patients who received a diagnosis of cholangiocarcinoma (CC) from the Taiwan Cancer Registry between 2003 and 2009. A total of 6,093 CC cases (ICC: 4,695; ECC: 1,396) and 60,906 matched controls were included. Compared with the controls, the patients with ICC and ECC were more likely to have DM, with an adjusted OR of 1.22 [95% confidence interval (CI): 1.07–1.39] and 1.48 (95% CI: 1.18–1.85), respectively. DM was associated with an increased risk of CC in the women and patients without a history of biliary tract diseases. Moreover, compared with the controls, DM was not associated with an increased risk of ECC in the patients who received cholecystectomy. These findings strongly support the positive association between DM and the increased risk of both ICC and ECC; however, this association was not observed in the patients who received cholecystectomy.

Risk factors for intrahepatic cholangiocarcinoma: a systematic review and meta-analysis

“…The research data were collected during the period from 1992 to 2014, involving a total of 330896 participants. Two studies reported no significant association between NAFLD and ICC [22,25], but the remaining six studies showed a significant association [6,9,12,23,32,36]. Our meta-analysis showed that NAFLD was a risk factor for ICC with pooled OR of 2.23 (95% CI 1.65-3.02; I 2 =76%) (Fig.…”

“…1). Of the 32 included studies, nine were conducted in the United States [5][6][7][8][9][10][11][12][13][14], eight in China [15][16][17][18][19][20][21][22], four in Taiwan (China) [23][24][25][26], three in Korea [27][28][29], two in Italy [30,31], three in Japan [32][33][34], one in Denmark [35], and one in 10 European countries [36]. The characteristics of the 32 included studies are summarized in Table 1.…”

“…Sixteen case-control studies investigated the association between cirrhosis and ICC [5,6,9,10,12,13,16,18,19,22,23,25,26,29,34,35]. Of them, six studies were from the United States, four from China, three from Taiwan (China), and one each was from Japan, Denmark and Korea.…”

“…Eight case-control studies investigated the association between NAFLD and ICC [6,9,12,22,23,25,32,36]. Of them, one was from 10 European countries, three were from the United States, two from Taiwan (China), and one each was from China and Japan.…”

Non-Alcoholic Fatty Liver Disease as a Risk Factor for Cholangiocarcinoma: A Systematic Review and Meta-Analysis

“…Two hundred and three studies were excluded due to the following reasons: NAFLD was not assessed in the study (n = 149); the case group was not diagnosed with CCA (n = 25); no control group in the study (n = 13); and irrelevant study (n = 16). There were ten potential relevant studies, of which studies from Chaiteerakij et al [14] and Haung et al [15] were excluded because their patient cohort was a part of the cohort in studies of Choi et al [16] and Chang et al [17], respectively (detail in Additional file 2: Data S3). Finally, eight studies met the criteria: seven case-control studies and one cohort study.…”