Introduction The incidence of hepatobiliary and gall bladder cancers is increasing. The age standardised incidence rates of liver cancers has increased by 224% for males and 227% for females over the last few decades with similar trends in the incidence of bile duct and gall bladder cancers. It is unclear if this rise is related to increasing trends in in obesity, metabolic syndrome and lifestyle changes. The current evidence base is unclear.
Aim To determine the association between obesity, metabolic syndrome and hepatobiliary cancer using primary care data.
Method A nested case-control study was performed using the THIN (The Health Improvement Network) database in the UK. Read codes were used to capture patients with a diagnosis of liver, bile duct and gall bladder cancers and these patients were matched in a 1:2 fashion with controls without a diagnosis of cancer by age, GP practice and gender, with at least one year of follow up on the database. Data on co-morbidities, events (GP or hospital visits), drug history, anthropometric data (weight, log-transformed body mass index (BMI), blood pressure, cholesterol and glucose levels) and data on smoking and alcohol consumption was extracted from the database and analysed in an analytical model for potential associations between hepatobiliary cancer and obesity/metabolic syndrome.
Results 4287 patients (62% male, 38% female) with hepatobiliary cancers were matched with 8574 controls. On univariate analysis, age (0.99 (0.98–0.99), p<0.001), log BMI (3.223 (2.58–4.03), p<0.001), smoking (38.62 (31.47–47.4), p<0.001), diabetes (2.12 (1.94–2.31), p<0.001), ischaemic heart disease (IHD) (2.06 (1.85–2.29), p<0.001) were associated with hepatobiliary cancer. Interestingly, statin use (0.71 (0.65–0.78), p<0.001) had a negative association with hepatobiliary cancer and PPI use (3.36 (3.09–3.65), p<0.001) had a positive association.
On step-wise forward conditional logistic regression, age (0.98 (0.977–0.98), p<0.001), smoking (34.58, (28.09–42.57), p<0.001), diabetes (2.28 (2.05–2.53), p<0.001), IHD (1.36 (1.2–1.54), p<0.001), PPI use (2.97 (2.71–3.26), p<0.001) and statin use (0.52 (0.47–0.58), p<0.001) were associated with the risk of hepatobiliary cancers.
On modelling log BMI, diabetes and hypertension as a single covariate, there was a significant association of a combination of BMI, diabetes and hypertension with hepatobiliary cancer (1.59 (1,49–1.69), p<0.001).
Conclusion Obesity and metabolic syndrome is significantly associated with the risk of hepatobiliary cancer. Statin use seems to be protective.
Disclosure of Interest None Declared
- HEPATOBILIARY CANCER
- METABOLIC SYNDROME