Risk factors of gallbladder cancer in Karachi-a case-control study

World Journal of Surgical Oncology

Hasnain Zafar¹  Nadeem Ahmed Siddiqui¹  A Rehman Alvi¹ 

[1] Department of Surgery, Aga Khan University Hospital, Karachi-74800, Pakistan

关键词: Risk factors for gallbladder cancer;    Prophylactic cholecystectomy;    Gall bladder cancer;   

Others  :  1206588
DOI  :  10.1186/1477-7819-9-164

 received in 2011-05-24, accepted in 2011-12-09,  发布年份 2011

【 摘 要 】

Background

Gallbladder carcinoma (GC) is a relatively rare malignancy worldwide but is the second commonest gastrointestinal cancer in Pakistani women. Gallstones have a positive association with GC but other factors also influence in causation.

Methods

This is a retrospective case control study over a period of 19 years. The cases (Group A) were patients with histopathological proven carcinoma gallbladder (N = 60) and controls were patients with cholelithiasis but no carcinoma gallbladder on histopathology (N = 120). Multivariate regression analysis was done to calculate the odds ratio, 95% confidence interval and P-Value. A positive relationship was found between size of stone > 1 cm, solitary stone, age > 55 years and multi-parity in women.

Results

There were 60 patients in Group A and 120 patients in Group B. mean age of diagnosis in Group A patients was 57 ± 2.4 years while mean age of diagnosis in Group B patients was 48 ± 1.35 years. Sixty seven percent of cancer group patients were female as compared to 78% females in non-cancer group. In Group A, 69% of female patients were multiparous (parity of more than 5) while 43% of group B patients were multiparous. For body mass index (BMI), both groups were not very different in our study population i.e. around 78% patients in each group has BMI of more than 23 Kg/m2. In Group A, 37% (n = 22) have solitary stones as compared to 15% (n = 18) in group B. similarly Group A patients has larger stone size as compared to Group B i.e.59% (n = 36) patients in Group A have stones of more than 1 cm when compared to 35% (n = 41) patients in Group B. After using multivariate regression analysis, age more than 55 years (OR - 7.27, p value- < 0.001), solitary stone (OR - 3.33, p value - 0.002) and stone of more than 1 cm (OR - 2.73, p value - 0.004) were found to be independent risk factors for development of gallbladder cancer.

Conclusion

Most of the patients (78%) with GC were female, and the statistically significant risk factors were older age, solitary stones and stones size more than one centimeter. A case can be made for prophylactic cholecystectomy in such a high risk group. However a population based study is required to calculate the true incidence of GC in Karachi and a prospective multi center study is needed to produce strong evidence for screening and prophylactic cholecystectomy.

Trial Registration

As this was a retrospective review of medical records, as per institution policy, its gives waiver from any registration (ethical/trial).

【 授权许可】

   
2011 Alvi et al; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Eduardo C, Lazcano P, Miquel JF: Epidemiology and molecular pathology of gallbladder cancer. CA Cancer JClin 2001, 51:349-364.
• [2]Giorgia R, Silvia F, Carlo la V: Gallbladder cancer worldwide: Geographical distribution and risk factors. Int J Cancer 2006, 118:1592-1602.
• [3]Talat JH, Sarwar A J: Risk Factors for Gallbladder Cancer in Karachi. J Ayub Med Coll Abbottabad 2003.
• [4]Bhurgri Y, Bhugri A, Hassan SH: Cancer Incidents in Karachi Pakistan: First results from Karachi cancer registry. Int J Cancer 2000, 85:325-9.
• [5]Mohandas KM, Patil PS: Cholecystectomy for asymptomatic gallstones can reduce gall bladder cancer mortality in northern Indian women. Indian J Gastroenterology 2006, 25:147-151.
• [6]Shukla VK, Chauhan VS, Mishra RN, Basu S: Lifestyle, reproductive factors and risk of gallbladder cancer. Singapore Med j 2008, 49:912-915.
• [7]John AP, Ashley R, Alan G: Primary carcinoma of the gallbladder. HBP 1991, 4:277-289.
• [8]Ivan R, Gilda I, Juan R: Gallstones and gallbladder cancer-volume and weight of gallstones are associated with gallbladder cancer: a case control study. Journal of surgical oncology 2006, 93:624-628.
• [9]Nervi F, Duarte I, Gomez G, Rodriguez G, Del Pino G, Ferrerio O, Covarrubias C, Urzua A: Frequency of gallbladder cancer in chile, a high-risk area. Int J Cancer 1988, 15;41(5):657-60.
• [10]Zou S, Zhang L: Relative risk factors analysis of 3922 cases of gallbladder cancer. ZhonghuaWaiKeZaZhi 2000, 38:805-808.
• [11]Abdul Q: Patients with gallbladder cancer: a clinical experience. Pak J Med 2007, 23:298-300.
• [12]Ann WH, Yan B, Gabriella A: Family history of biliary cancer and gallstones: a population -based study in Shanghai, China. Int J Cancer 2007, 121:832-838.
• [13]Zatonski WA, Lowenfels AB, Boyle P: Epidemiologic Aspects of Gallbladder Cancer: a case-control study of the SEARCH program of the international agency for research on cancer. Journal of national cancer institute 1997, 89:1132-1138.
• [14]Hemminki K, Li X: Familial liver and gallbladder cancer: a nationwide epidemiological study from Sweden. Gut 2003, 52:592-596.
• [15]Tamotsu K, Yoshitsugu T, Kei M: Genetic Alterations in gallbladder carcinoma. Surg today 2005, 35:101-105.
• [16]Yun L, Bing YZ, Jing SS, Li-Kun W: Expression of bacterial gene in gallbladder carcinoma tissue and bile. Hepatobiliary Pancreatic Dis Int 2004, 3:133-135.
• [17]Vitetta L, Sali A, Little P: Gallstones and gallbladder carcinoma. Blackwell Pub 2009, 1.
• [18]Sanjay M, Steve KL: Putative precof gallbladder dysplasia: a review of 400 routinely resected specimens. Archi of pathology and Medicine 2005, 129:386-390.
• [19]Susumu T, Goro K: Carcinogenesis of malignant lesions of the gall bladder: the impact of chronic inflammation and gallstones. Langenbeck's Arch Surg 2001, 386:224-229.
• [20]Arundhati R, Mohatpatra SC: A review of association of dietry factors in gallbladder cancer. Indian journal of cancer 2004, 41:147-151.
• [21]Ricardo O, Carmen S: Socio-economic level, farming activities and risk of cancer in small areas of Southern Spain. European j Epidemiology 2004, 19:643-650.