Endoscopy 2020; 52(S 01): S29
DOI: 10.1055/s-0040-1704091
ESGE Days 2020 oral presentations
Friday, April 24, 2020 17:00 – 18:30 Advances in endoluminal and biliopancreatic endoscopy The Liffey A
© Georg Thieme Verlag KG Stuttgart · New York

INCIDENCE AND SURVIVAL OF HEPATOCELLULAR CARCINOMA AND BILE DUCT CANCER IN PATIENTS WITH GALLSTONES OR CHOLECYSTECTOMY: A POPULATION-BASED COHORT STUDY

SM Park
1   Chungbuk National University College of Medicine, Internal Medicine, Cheongju, Korea, Republic of
2   Chungbuk National University Hospital, Cheongju, Korea, Republic of
,
HJ Kim
3   Korea University College of Medicine, Preventive Medicine, Seoul, Korea, Republic of
,
HS Ahn
3   Korea University College of Medicine, Preventive Medicine, Seoul, Korea, Republic of
› Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2020 (online)

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Aims It is debatable whether gallstones or cholecystectomy increase the risks of hepatocellular carcinoma (HCC) and bile duct cancer (BDC). We evaluated the risk and prognosis of HCC and BDC in patients with gallstones treated with or without cholecystectomy and compared them with healthy controls.

Methods We identified patients with gallstones (n=480,688; follow-up: 12 years, 2002-2016) and age- and sex-matched healthy controls (1:10) from Korean National Health Insurance data. The incidence and survival rates of HCC (C22.0) and BDC (C22.1/C24.0-C24.9) were compared. Possible risk factors such as sex, age, metabolic syndrome-related parameters (hypertension, obesity, hyperlipidemia, and hyperglycemia), liver enzyme levels, and smoking and drinking habits were adjusted.

Results Compared to controls, patients with gallstones without cholecystectomy had 4.23-fold and 4.87-fold higher incidences of HCC (107.69/105 person-year [PY]) and CCC (33.85/105 PY), respectively. Cholecystectomy was performed in 132,901 patients with gallstones (27.6%); 87.5% of them were diagnosed as acute cholecystitis, cholangitis or acute pancreatitis. Compared to patients with gallstones without cholecystectomy, the incidences of patients with gallstones treated with cholecystectomy decreased in HCC (38.43/105 PY) and BDC (13.90/105 PY). After adjustment of other risk factors, hazard ratios (HR) of HCC and BDC in patients with gallstones treated with cholecystectomy were 1.42 and 2.27, respectively, which were lower in those treated without cholecystectomy; HCC 2.74 and BDC 4.66 compared to controls. Survival rates of HCC or BDC were higher in patients with gallstones than controls. Whether cholecystectomy or not did not influence on survival rates.

Conclusions Risks of HCC and BDC increased in patients with symptomatic gallstones, which partially decreased after cholecystectomy. Patients with gallstones revealed better prognosis of HCC or BDC than controls.