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Meta-analysis identifies risk factors for primary liver cancers

Factors including cirrhosis, chronic HBV/HCV infection, obesity, diabetes and alcohol use were linked to an increased risk for intrahepatic cholangiocarcinoma in a recent study.

In a literature review and meta-analysis, researchers evaluated data from 11 case-control studies on intrahepatic cholangiocarcinoma (IH-CCA) and associated risk factors. Tests were graded according to heterogeneity, bias and sensitivity, and ORs for potential factors for IH-CCA were calculated according to reported results.

Using data from seven studies incorporating 399,608 patients, investigators calculated a combined OR of 22.92 (95% CI, 18.24-28.79) for cirrhosis for the development of IH-CCA, and subsequently evaluated individual known risk factors for cirrhosis to establish whether they also increased risk for IH-CCA, with the following results:

• HBV: Eight studies incorporating 294,828 patients, with a combined OR of 5.10 (95% CI, 2.91-8.95)
• HCV: Eight studies incorporating 396,754 patients, with a combined OR of 4.84 (95% CI, 2.41-9.71)
• Obesity: Three studies incorporating 304,134 patients, with a combined OR of 1.56 (95% CI, 1.26-1.94)
• Type 2 diabetes: Nine studies incorporating 400,167 patients, with a combined OR of 1.89 (95% CI, 1.74-2.07)
• Tobacco use: Eight studies incorporating 396,347 patients, with a combined OR of 1.31 (95% CI, 0.95-1.82)
• Alcohol consumption: 10 studies incorporating 398,048 patients, with a combined OR of 2.81 (95% CI, 1.52-5.21)

Significant heterogeneity was observed in studies evaluating alcohol (Q=90.3, I²=90.0%), HBV (Q=51.2, I²=86.3%), HCV (Q=42.7, I²=83.6%) and smoking (Q=41.4, I²=83.1%). No evidence of publication bias was found for any studies. Researchers performed sensitivity analysis on all studies excluding those evaluating obesity, and found a significant difference in OR only for tobacco use.

“Liver cirrhosis is associated with increased risk for intrahepatic cholangiocarcinoma,” Tushar C. Patel, MB, ChB, professor of medicine in the division of gastroenterology and hepatology at the Mayo Clinic in Jacksonville, Fla., told Healio.com. “[Clinicians should] recognize the increased risk and consider the diagnosis of IH-CCA in patients at risk.”