饮茶与胆道癌胆石症关系的全人群病例对照研究

目的 探讨饮茶与胆道癌和胆石症的关系。方法 采用全人群病例对照研究。研究对象为上海市区新发胆道癌患者627例,包括胆囊癌368例,肝外胆管癌191例和壶腹癌68例;按年龄（每5岁1组）频数配对的对照人群959人;同时收集胆石症患者1037例。采用非条件Logistic回归模型,分析饮茶与胆道癌、胆石症的关系。结果 与不饮茶者比较,女性胆囊癌、肝外胆管癌和胆石症组中现仍饮茶者的调整OR分别为0．57（95％CI：0．34～0．96）、0．53（95％CI：0．27～1．03）和0．71（95％CI：0．51～0．99）,肝外胆管癌OR值随饮茶年龄的提前及饮茶年限的增加而降低,趋势检验达到显著性水平。男性胆囊癌、肝外胆管癌和胆石症组OR均〈1,但尚无统计学意义。结论 饮茶对女性胆囊癌、肝外胆管癌可能具有保护作用,这一保护作用不依赖于胆石症而具有独立性。     

吸烟、饮酒与胆道癌关系的全人群病例对照研究

 目的　探讨吸烟、饮酒与胆道癌的关系。方法　采用全人群病例对照研究 ,研究对象为 1997年6月 1日～ 2 0 0 1年 5月 31日期间确诊的、年龄在 35～ 74岁的上海市区 6 2 7例胆道癌新发病例以及按性别、年龄 (5岁一组 )频数配对的 95 9例人群对照。采用非条件logistic回归模型分析吸烟、饮酒与胆道癌的关系。结果　男性中 ,吸烟对肝外胆管癌和壶腹癌各组的调整OR均大于 1,现仍吸烟者的调整OR分别为 1.5 1(95 %CI:0 .86～ 2 .6 6 ) ,1.5 8(95 %CI:0 .6 9～ 3.5 8) ;OR随吸烟年限增加和开始吸烟年龄提早有所升高 ,但均未达显著水平。饮酒对胆道癌各组OR均无统计学意义。结论　吸烟也许与肝外胆管癌、壶腹癌有联系 ,未发现吸烟与胆囊癌的显著性关联 ;未发现饮酒与胆道癌的显著性关联。     

胆道肿瘤内科治疗进展

胆道肿瘤(biliary tract cancer,BTC)系一组起源于胆囊和胆管上皮的恶性肿瘤,包括胆囊癌、胆管癌(肝内、肝外胆管)和壶腹部癌,90%以上为腺癌。最新数据显示,目前肝内胆管癌的发病率和死亡率呈上升趋势,而肝外胆管癌的发病率及死亡率已经     

上海市胆道癌病理形态特征的初步观察:附487例分析

目的研究上海市区居民胆道癌病理形态特征和鉴别诊断.方法自1997年6月～2001年5月在上海市区开展基于全人群的胆道癌病例-对照研究,总共收集病理切片1 228例,包括胆道癌487例(其中胆囊癌322例,肝外胆管癌105例和壶腹癌60例),胆道结石和胆囊炎对照病例721例,胆道腺瘤20例,由中、美资深病理医师复查,按世界卫生组织1991年胆囊和肝外胆管肿瘤组织学分型进行分类.结果病理标本以切除标本为主,肿瘤大小为多数小于4 cm,组织学类型中70%以上为腺癌,肿瘤组织学分级以高分化和中分化占绝大多数,TNM分期中0～Ⅱ期的胆囊癌和肝外胆管癌约占1/3,壶腹癌近2/3.病理复查结果显示诊断过头占1.8%,诊断不足占0.6%,漏诊占0.1%;随访结果显示根治术后的5年生存率:胆囊癌40.7%、肝外胆管癌11.1%和壶腹癌26.9%.结论病理复查可以统一诊断标准,提高确诊率,为全人群病例-对照研究和多学科协作积累经验.     

既往疾病史和胆道癌关系的全人群病例对照研究

目的　研究分析既往疾病史和胆道癌 (包括胆囊癌、肝外胆管癌和壶腹部癌 )的关系。方法　自 1997年 6月～ 2 0 0 1年 5月 ,在上海市区开展了一项大规模的基于全人群的胆道癌的病例对照研究 ,共收集、调查了 6 6 4例胆道癌新病例和 894例人群对照。结果　研究发现既往有胆囊炎疾病史者患胆囊癌、肝外胆管癌的危险性升高 ,调整的比数比分别为 2 .2 (95 %CI =1.3～ 3.6 )和 1.9(95 %CI=1.0～ 3.3)。糖尿病患者患胆囊癌的危险性增加 ,调整的比数比为 1.5 (95 %CI=0 .9～ 2 .5 ) ,在非胆结石者中调整的比数比为 2 .0 (95 %CI=0 .9～ 4 .5 ) ;此外 ,研究还发现肝硬化者患肝外胆管癌的危险性明显增加 ,调整的比数比为 3.0 (95 %CI=1.0～ 9.1) ,在非胆结石者中调整的比数比为 4 .9(95 %CI=1.2～ 19.8)。结论　该项研究为论证胆囊炎症增加患胆道癌的危险性提供了依据 ,研究还提示糖尿病和肝硬化分别提高患胆囊癌和肝外胆管癌的危险性。     

饮食与胆囊癌关系的流行病学研究

目的探讨饮食因素与胆囊癌发病的关联,为采取预防措施提供科学依据.方法采用全人群病例对照研究,研究对象为1997年6月～2001年5月期间确诊的、年龄在35～74岁的上海市区368例胆囊癌新发病例以及按性别、年龄(5岁一组)频数配对的895例人群对照.采用非条件logistic回归模型分析饮食各因素与胆囊癌的关系.结果女性中,与最低四分位数组相比,葱属类蔬菜年摄入次数最高四分位组的调整OR为0.55(95%CI:0.31～0.97;Ptrend=0.06);与不吃组比较,大蒜头和洋葱最高摄入组的调整OR分别为0.59(95%CI:0.34～0.99;Ptrend=0.03)和0.52(95%CI:0.30～0.91;Ptrend=0.01).与最低四分位组比较,腌制品摄入其余各组调整OR在女性中依次为1.06、1.88、2.31,Ptrend＜0.001;与不吃乳腐组比较,余三组的调整OR依次为1.19、1.47、1.88,Ptrend＜0.01.男性结果与女性类似,腌制品和葱属类蔬菜摄入的各组OR都有不显著的升高和降低.结论新鲜蔬菜,尤其是葱属类蔬菜对胆囊癌的保护作用在女性比男性明显,而且以大蒜头、洋葱的保护作用较为显著.而腌制品摄入,尤其是乳腐,可能会增加胆囊癌的发病风险.     

肝外胆管癌和胆囊癌术后辅助放疗与未放疗疗效比较的Meta分析

目的 采用Meta分析方法比较肝外胆管癌和胆囊癌术后辅助放疗与未放疗间的疗效差异。方法 计算机检索PubMed、EMbase、Cochrane图书馆、万方、维普、CNKI及中国生物医学等数据库,搜集有关肝外胆管癌和胆囊癌术后辅助放疗与未放疗比较的临床对照研究资料,汇总数据采用RevMan5.3和Stata14.0软件进行分析。两组间差异采用OR及 95%CI描述。结果 最终纳入20个包括 1258例患者的临床对照研究资料。Meta分析结果显示,与肝外胆管癌和胆囊癌术后未行放疗相比,辅助放疗组 5年生存率更高(OR=1.67,95%CI为 1.29~2.18,P=0.001)。术后辅助放疗能明显提高切缘阳性(OR=3.43,95%CI为 1.56~7.75,P=0.002)以及淋巴结阳性(OR=7.44;95%CI为1.24~44.72,P=0.03)患者的 5年生存率。此外,术后辅助放疗组的局部复发率更低(OR=0.56,95%CI为 0.39~0.80,P=0.01),但远处转移率两组相似(OR=1.22,95%CI为 0.86~1.73,P=0.270)。放疗所致≥3级急性毒性及慢性毒性反应发生率分别为 0~11.9%和 0~21.7%。结论 与肝外胆管癌和胆囊癌术后未行放疗相比,术后辅助放疗是有效且安全的治疗方法。     

核苷酸切除修复基因和谷胱甘肽-S-转移酶基因多态与胆道癌风险关系的研究

目的:研究核苷酸切除修复基因XPA、XPC、XPD、XPG及Ⅱ相代谢酶基因GSTM1、GSTT1多态与上海市市区人群胆道癌风险的关系.方法:采用全人群病例-对照研究的方法,运用聚合酶链反应-限制性片段长度多态(polymerase chain reaction-restriction fragment length polymorphism,PCR-RFLP)的方法对443例胆道癌患者和845例正常对照进行基因型分析.比较各基因型在病例与对照中分布频率的差异,并探讨其与胆道癌之间的关系.结果:XPD exon10-Asp312Asn和exon23-Lys751Gln多态位点的频率分布在壶腹癌病例和对照之间的差异有统计学意义(P<0.05),调整了年龄、性别、吸烟、胆石症和高血压后,证实Asn/Asn和Gln/Gln基因型可能增加壶腹癌的危险, 比值比(odds ratio,OR)分别为32.03和9.33,且趋势检验有统计学意义.未发现其他修复基因多态位点与胆道癌有关联.分层分析显示,GSTM1缺失型可增加女性胆囊癌发生的危险,OR=1.73(95%可信区间:1.06～2.82).在胆道癌的发生中,GSTM1与部分修复基因存在联合作用.结论:XPD exon10-Asn/Asn基因型和exon23 Gln/Gln基因型可能与壶腹癌的危险性有关.GSTM1缺失型可能增加女性胆囊癌发生的危险,且GSTM1基因型与部分修复基因之间可能存在联合作用.     

p16和Rb在胆道良及其意义恶性病变中的表达及其意义

目的研究p16、Rb在胆道良恶性病变中的表达和临床意义.方法应用免疫组化S-P法测定41例肝外胆管癌中p16、Rb的表达,以13例慢性胆管炎作为对照.结果肝外胆管癌组p16阳性率为51.2%(21/41).其中,高中分化癌组、低分化癌组、转移组、无转移组阳性率分别为53.6%(15/28)、46.2%(6/13)、31.3%(5/16)和64.0%(16/25);胆管炎组阳性率为92.3%(12/13).肝外胆管癌组与胆管炎组间、无转移组与转移组间差异有显著性(P<0.01,P<0.05),高中分化癌组与低分化癌组间差异无显著性(P>0.05).肝外胆管癌组Rb阳性率为58.5%(24/41).其中,高中分化癌组、低分化癌组、转移组、无转移组Rb阳性率分别为71.4%(20/28)、30.8%(4/13)、37.5%(6/16)和72.0%(18/25);胆管炎组阳性率为92.3%(12/13).肝外胆管癌组与胆管炎组间、高中分化癌组与低分化癌组间、无转移组与转移组间差异有显著性(P<0.05).24例Rb阳性病例中,p16阳性率为37.5%(9/24);17例Rb阴性病例中,p16阳性率为70.6%(12/17),两者表达呈负相关(P<0.05),Kendall相关系数τb=-0.33.结论肝外胆管癌组织中存在p16、Rb异常表达,均与转移有关,Rb异常表达还与肝外胆管癌病理分级有关.上述两指标可作为判断患者预后的参考指标.     

胆总管癌

胆道系统中肝外胆管癌较多,多能手术切除。有资料表明胆总管下段癌比上段癌术后存活时间长。由于术前诊断及术中分期方法的改进,使肝外胆管癌早期诊断和成功根治术的病例选择取得了成果。分析1954～1988年的62例胆总管中、下段癌。男42例,女20例。平均年龄58岁。诊断的主要依据为胆总管扩张的局部改变。随访45     

Body Mass Index （BMI）, Waist to Hip Ratio （WHR） and Risk of Biliary Tract Cancers： A Population-based Case-control Study in Shanghai, China

OBJECTIVE To investigate the relationship between BMI, WHR and biliary tract cancers (CBT).METHODS A population-based case-control study was conducted in urban Shanghai from June 1, 1997 to May 31,2001 involving interviews with 627 new cases of biliary tract cancers aged 35 to 74 years and 959 frequency-matched population controls by gender and age in five-year groups. All subjects were interviewed in person by trained interviewers using a structured questionnaire. An unconditional logistic regression was performed to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CIs).RESULTS Obesity was associated with an increased risk of gallbladder cancer across adulthood at ages 20-29 and 30-39 in females. Compared with subjects in the lowest quartile of WHR, ORs for the highest quartile and P for trend for cancers of gallbladder and extrahepatic bile duct both reached significant levels among males and females.CONCLUSION Our observations in urban Shanghai suggested that obesity in early adult life may contribute to the risk of gallbladder cancer, and increased WHR may substantially elevated risk of cancers of the gallbladder and extrahepatic bile duct.     

Body Mass Index (BMI), Waist to Hip Ratio (WHR) and Risk of Biliary Tract Cancers: A Population-based Case-control Study in Shanghai, China

OBJECTIVE To investigate the relationship between BMI, WHR and billary tract cancers (CBT).METHODS A population-based case-control study was conducted in urban Shanghai from June 1, 1997 to May 31, 2001 involving interviews with 627 new cases of biliary tract cancers aged 35 to 74 years and 959frequency-matched population controls by gender and age in five-year groups. All subjects were interviewed in person by trained interviewers using a structured questionnaire. An unconditional logistic regression was performed to calculate adjusted odds ratios (Ors) and 95% confidence intervals (Cis).RESULTS Obesity was associated with an increased risk of gallbladder cancer across adulthood at ages 20-29 and 30-39 in females. Compared with subjects in the lowest quartile of WHR, Ors for the highest quartile and P for trend for cancers of gallbladder and extrahepatic bile duct both reached significant levels among males and females.CONCLUSION Our observations in urban Shanghai suggested that obesity in early adult life may contribute to the risk of gallbladder cancer, and increased WHR may substantially elevated risk of cancers of the gallbladder and extrahepatic bile duct.     

Body size and prostate cancer: a population-based case-control study in China.

We conducted a population-based case-control study in China to investigate whether body size plays a role in prostate cancer etiology and whether it can explain the rapid increase in prostate cancer incidence rates in China. A total of 238 cases newly diagnosed with primary prostate cancer in Shanghai, China, during 1993-1995 were included in the study. Four hundred and seventy-one healthy control subjects were randomly selected from among residents of Shanghai and frequency-matched to cases on the basis of age. In-person interviews were conducted to elicit information on height, weight history, and other lifestyle factors. Waist and hip circumferences were measured at interview. Odds ratios (ORs) were used to measure the association between prostate cancer and anthropometric variables including height, weight, body mass index (BMI), waist, hip, and right upper arm circumferences, and waist-to-hip ratio (WHR; an indicator of abdominal adiposity). High levels of WHR were related to an excess risk, with men in the highest quartile (WHR > 0.92) having an almost 3-fold risk (OR, 2.71; 95% CI = 1.66-4.41; Ptrend = 0.0001) compared with men in the lowest quartile (WHR < 0.86). In contrast, men in the highest quartile of hip circumference (>97.4 cm) had a reduced risk (OR, 0.46; 95% CI = 0.29-0.74; Ptrend = 0.0002) relative to men in the lowest quartile (<86 cm). No association was found for height, usual adult weight, or preadult and usual adult BMI. Our results suggest that even in a very lean population (average BMI = 21.9), abdominal adiposity may be associated with an increased risk of clinical prostate cancer, pointing to a role of hormones in prostate cancer etiology. Additional research is needed to confirm these findings in prospective studies, especially in Western populations where abdominal obesity is much more common, and to clarify the underlying hormonal mechanisms involved.     

Diet and colon cancer: assessment of risk by fiber type and food source

How fiber in the diet is related to the development of colon cancer was assessed in a population-based study conducted on 231 cases and 391 controls in Utah between 1979 and 1983. Crude fiber consistently decreased risk associated with colon cancer in both males [odds ratio (OR) = 0.4] and females (OR = 0.5). Dietary fiber, as analyzed by the method of A. S. Bitner, and neutral detergent fiber were not consistently related to colon cancer risk. Of the noncellulose polysaccharides examined, mannose and galactose were protective against cancers in the ascending colon in males (ORs = 0.5 and 0.3, respectively), whereas galactose and uronic acid were protective against cancers in the ascending colon in females (ORs = 0.5). Highest quartiles of intake of fruits and vegetables were also associated with a decreased risk of colon cancer in males (ORs = 0.3 and 0.6, respectively) and in females (ORs = 0.6 and 0.3, respectively) compared with lowest quartile of intake, whereas high intake of grains was not protective.     

Serum carotenoids and mortality from lung cancer: a case-control study nested in the Japan Collaborative Cohort (JACC) study

To investigate whether high serum levels of carotenoids, tocopherols, and folic acid decrease risk of lung cancer in Japanese, we conducted a case-control study nested in the Japan Collaborative Cohort (JACC) Study. A total of 39 140 subjects provided serum samples at baseline between 1988 and 1990. We identified 147 cases (113 males and 34 females) of death from lung cancer during an 8-year follow-up. Of the subjects who survived to the end of this follow-up, 311 controls (237 males and 74 females) were selected, matched to each case of lung cancer death for gender, age and participating institution. We measured serum levels of antioxidants in cases of lung cancer death and controls. Odds ratios (ORs) for lung cancer death were estimated using conditional logistic models. The risk of lung cancer death for the highest quartile of serum α-carotene, β-carotene, lycopene, β-cryptoxanthin, and canthaxanthin was significantly or marginally significantly lower than for the lowest quartile: the ORs, adjusted for smoking and other covariates, were 0.35 (95% confidence interval (Cl), 0.14–0.88), 0.21 (0.08–0.58), 0.46 (0.21–1.04), 0.44 (0.17–1.16) and 0.37 (0.15–0.91), respectively. The ORs for the highest serum levels of zeaxanthin/lutein and folic acid tended to be low, but the differences were not statistically significant. Serum total cholesterol was also inversely related to risk of lung cancer death: the OR for the highest vs. the lowest quartile was 0.39 (95% Cl, 0.19–0.79). Higher serum levels of carotenoids such as α- and β-carotenes may play a role in preventing death from lung cancer among Japanese. (Cancer Sci 2003; 94: 57–63)     

Risk factors for extrahepatic bile duct cancers: Los Angeles County,California (USA)

Extrahepatic bile duct (EBD) cancers are rare and their risk factors are poorly understood. Except for a history of gallbladder diseases, evidence for other potential risk factors, such as excess body weight and use of tobacco and alcohol, is scant. A case-control study was conducted to examine risk factors for EBD cancers, including ampulla of Vater tumors, among Los Angeles County (California, USA) residents. Included were 105 histologically confirmed cases diagnosed between 1 March 1985 and 31 October 1989, aged 30 to 84 years, and 255 population-based controls frequency-matched to cases by gender and age in five-year groups. Cases and controls were interviewed about their demographic background and potential risk factors, including tobacco, alcohol, and beverage consumption, diet, medical history, and reproductive factors among women. For deceased cases, their next-of-kin were interviewed. Risk of cancers of both subsites of extrahepatic duct and ampulla of Vater increased with smoking of cigars/pipes or cigarettes. For both men and women, risks increased twofold or more among those who smoked cigarettes for 50 or more pack-years. While a history of gallbladder diseases substantially increased the risk of cancers of both subsites, excess body mass index was associated only with cancer of extrahepatic duct subsite (odds ratio [OR]=4.0, 95 percent confidence interval [CI]=1.1–14.2 among men and OR=2.7; CI=0.8–9.4 among women in the highest quartile relative to those in the lowest quartile). Alcohol drinkers had lower risks compared with nondrinkers, but no consistent trend was observed with amount consumed. No consistent patterns of risks were found for coffee, tea, diet, occupation, or reproductive factors. These results suggest that lifestyle-related factors, such as use of tobacco and excess body weight, play a role in EBD cancer risk.     

Anthropometric Measurements and Epithelial Ovarian Cancer Risk in African–American and White women

Previous studies of anthropometric factors and ovarian cancer risk have been inconsistent and none have evaluated the association among African–American women. Data from a population-based, case–control study of 593 cases and 628 controls were used to evaluate ovarian cancer risk in relation to weight, height, body mass index (BMI) and waist-to-hip ratio (WHR). Odds ratios (ORs) and 95% confidence intervals (CIs) were computed and established risk factors were adjusted for using logistic regression models, stratified by race. Among all races, weight at age 18, WHR, weight and BMI one year prior to interview were associated with elevated ovarian cancer risk. When stratified by race, the association between WHR and ovarian was similar among Whites and among African Americans. However, African–American women in the fourth quartile of height had an elevated risk of ovarian cancer (OR = 3.2; 95% CI = 1.3–7.8), but this risk was not apparent in Whites (OR = 1.0; 95% CI␣ = 0.7–1.4). These findings support the hypothesis that obesity is an important risk factor of ovarian cancer among African–Americans and Whites and also suggest that height may be a risk factor specific to African–Americans.^★ This work was performed at the Duke University Comprehensive Cancer, Durham, NC, USA.     

Diabetes mellitus and cancer risk in a population-based case-control study among men from Montreal, Canada

Diabetics may have a higher risk of cancer, notably liver and pancreatic cancers. Evidence about other cancer types remains sparse. The authors examined potential associations between diabetes and several types of cancer in a large multicancer case-control project carried out in Montreal, Canada, in the 1980s. This report, based on 3,107 male cancer cases and 509 population controls, uses information on diabetes and several covariates collected by interview. Adjusted odds ratios (ORs) and 95% confidence intervals (CI) were estimated for the associations between diabetes and each of 12 cancer types. Risks of pancreatic and liver cancers were increased among diabetics: adjusted ORs were 2.1 (95% CI: 1.0, 4.3) for pancreatic and 3.1 (95% CI: 1.1, 8.8) for liver cancer. The increased risk of pancreatic cancer was completely restricted to those with recent onset of diabetes; this was likely a manifestation of reverse causality. Conversely, the increased risk of liver cancer was independent of the interval between diabetes and cancer diagnoses. No associations were observed with melanoma, non-Hodgkin's lymphoma, cancers of the esophagus, stomach, colon, rectum, lung, prostate, bladder and kidney. In conclusion, diabetes was associated with an increased risk of liver cancer among men, but with no other cancer type including pancreatic cancer.     

Body size and the risk of biliary tract cancer: a population-based study in China

Though obesity is an established risk factor for gall bladder cancer, its role in cancers of the extrahepatic bile ducts and ampulla of Vater is less clear, as also is the role of abdominal obesity. In a population-based case-control study of biliary tract cancer in Shanghai, China, odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for biliary tract cancer in relation to anthropometric measures, including body mass index (BMI) at various ages and waist-to-hip ratio (WHR), adjusting for age, sex, and education. The study included 627 patients with biliary tract cancer (368 gall bladder, 191 bile duct, 68 ampulla of Vater) and 959 healthy subjects randomly selected from the population. A higher BMI at all ages, including early adulthood (ages 20-29 years), and a greater WHR were associated with an increased risk of gall bladder cancer. A high usual adult BMI (>or=25) was associated with a 1.6-fold risk of gall bladder cancer (95% CI 1.2-2.1, P for trend <0.001). Among subjects without gallstones, BMI was also positively associated with gall bladder cancer risk. Regardless of BMI levels, increasing WHR was associated with an excess risk of gall bladder cancer risk, with those having a high BMI (>or=25) and a high WHR (>0.90) having the highest risk of gall bladder cancer (OR=12.6, 95% CI 4.8-33.2), relative to those with a low BMI and WHR. We found no clear risk patterns for cancers of the bile duct and ampulla of Vater. These results suggest that both overall and abdominal obesity, including obesity in early adulthood, are associated with an increased risk of gall bladder cancer. The increasing prevalence of obesity and cholesterol stones in Shanghai seems at least partly responsible for the rising incidence of gall bladder cancer in Shanghai.