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Autoimmune diseases as comorbidities for liver,gallbladder, and biliary duct cancers in Sweden |
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| Authors: | Kari Hemminki MD PhD Kristina Sundquist MD PhD Jan Sundquist MD PhD Asta Försti PhD Vaclav Liska MD PhD Akseli Hemminki MD PhD Xinjun Li MD PhD |
| Affiliation: | 1. Biomedical Center, Faculty of Medicine and Biomedical Center in Pilsen, Charles University in Prague, Pilsen, Czech Republic;2. Center for Primary Health Care Research, Lund University, Malmo, Sweden Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA Department of Functional Pathology, School of Medicine, Center for Community-based Healthcare Research and Education (CoHRE), Shimane University, Matsue, Japan;3. Center for Primary Health Care Research, Lund University, Malmo, Sweden Hopp Children's Cancer Center (KiTZ), Heidelberg, Germany Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany;4. Biomedical Center, Faculty of Medicine and Biomedical Center in Pilsen, Charles University in Prague, Pilsen, Czech Republic Department of Surgery, University Hospital, Charles University, School of Medicine in Pilsen, Pilsen, Czech Republic;5. Cancer Gene Therapy Group, Translational Immunology Research Program, University of Helsinki, Helsinki, Finland Comprehensive Cancer Center, Helsinki University Hospital, Helsinki, Finland;6. Center for Primary Health Care Research, Lund University, Malmo, Sweden |
| Abstract: | BackgroundAutoimmune diseases are associated with many cancers but there is a lack of population-based studies with different autoimmune diseases that have a long follow-up. This is also true of hepatobiliary cancers, which include hepatocellular cancer (HCC) and rarer entities of gallbladder cancer (GBC), intra- and extrahepatic cholangiocarcinoma (iCCA and eCCA), and ampullary cancer.MethodsDiagnostic data on 43 autoimmune diseases were collected from the Swedish Inpatient Register from 1987 to 2018, and cancer data were derived from the national cancer registry from 1997 onward. Relative risks were expressed as standardized incidence ratios (SIRs).ResultsIn a population of 13.6 million, 1.1 million autoimmune diseases were diagnosed and subsequent hepatobiliary cancer was diagnosed in 3191 patients (17.2% of cancers). SIRs for HCC were 2.73 (men) and 2.86 (women), 3.74/1.96 for iCCA, 2.65/1.37 for GBC, 2.38/1.64 for eCCA, and 1.80/1.85 for ampullary cancer. Significant associations between autoimmune disease and HCC were observed for 13 autoimmune diseases, with the highest risks being for autoimmune hepatitis (48.92/73.53, men/women) and primary biliary cirrhosis (38.03/54.48). GBC was increased after six autoimmune diseases, with high SIRs for ulcerative colitis (12.22/3.24) and men with Crohn disease (9.16). These autoimmune diseases were also associated with a high risk of iCCA, which had seven other associations, and eCCA, which had five other associations. Ampullary cancer occurrence was increased after four autoimmune diseases.ConclusionAn autoimmune disease is a common precursor condition for hepatobiliary cancers. This calls for careful control of autoimmune disease symptoms in each patient and encouragement to practice a healthy lifestyle. |
| Keywords: | comorbidity discharge data hepatocellular cancer immune disturbance risk factor |