Risk Factors for Cholangiocarcinoma: Aspirin-use and the Risk of Cholangiocarcinoma
Menée sur 2 395 patients atteints d'un cholangiocarcinome et sur 4 769 témoins, cette étude évalue l'association entre l'utilisation d'aspirine, la présence de différentes pathologies (cholangite sclérosante primitive, diabète, cirrhose) et le risque de développer un cholangiocarcinome intrahépatique, hilaire ou distal
Whether aspirin-use is protective against cholangiocarcinoma (CCA) remains unclear. We determined the association between aspirin-use and other risk factors for each CCA subtype individually. In a hospital-based case-control study, 2,395 CCA cases (1,169 intrahepatic, 995 perihilar and 231 distal) seen at Mayo Clinic, Rochester, MN from 2000 through 2014 were enrolled. Controls selected from the Mayo Clinic Biobank were matched 2:1 with cases by age, sex, race, and residence (n=4,769). Associations between aspirin-use, other risk factors and CCA risk were determined. 591 (24.7%) CCA cases and 2,129 (44.6%) controls took aspirin. There was a significant inverse association of aspirin-use with all CCA subtypes, with adjusted odds ratios (AOR) of 0.35 (95% confidence interval [CI], 0.29-0.42), 0.34 (95% CI, 0.27-0.42), and 0.29 (95% CI, 0.19-0.44), for intrahepatic, perihilar, and distal CCA, respectively, P<.001 for all. Primary sclerosing cholangitis (PSC) was more strongly associated with perihilar (AOR, 452.9; 95% CI, 104-999) than intrahepatic (AOR, 93.4; 95% CI, 27.1-322.2) or distal CCA (AOR, 34.0; 95% CI, 3.6-323.1), whereas diabetes was more associated with distal (AOR, 4.2; 95% CI, 2.5-7.0) than perihilar (AOR 2.9, 95% CI, 2.2-3.8) or intrahepatic CCA (AOR 2.5, 95% CI, 2.0-3.2). Non-PSC related cirrhosis was associated with both intrahepatic and perihilar CCA with similar AORs of 14. Isolated inflammatory bowel disease without PSC was not associated with any CCA subtype. Conclusions: Aspirin use was significantly associated with a 2.7 to 3.6-fold decreased risk for the 3 CCA subtypes. Our study demonstrates that individual risk factors confer risk of different CCA subtypes to different extents. This article is protected by copyright. All rights reserved.