Diabetes mellitus,insulin treatment,diabetes duration,and risk of biliary tract cancer and hepatocellular carcinoma in a European cohort |
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| Affiliation: | 1. Institute of Epidemiology, Christian-Albrechts University of Kiel, Kiel;2. Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal;3. Molecular Epidemiology Group, Max Delbrück Center for Molecular Medicine Berlin-Buch, Germany;4. International Agency for Research on Cancer (IARC-WHO), Lyon, France;5. Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, USA;6. Centre de Biologie République, Lyon, France;7. Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus;8. Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark;9. Inserm, Centre for research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women''s Health team, Villejuif;10. Univ Paris Sud, UMRS 1018, Villejuif;11. IGR, Villejuif, France;12. Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany;13. WHO Collaborating Center for Food and Nutrition Policies, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens;14. Hellenic Health Foundation, Athens, Greece;15. Department of Clinical and Experimental Medicine, Federico II University of Naples, Naples;16. Nutritional Epidemiology Unit, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan;17. Center for Cancer Prevention (CPO-Piemonte), Human Genetic Foundation (HuGeF), Torino;18. Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute – ISPO, Florence;19. Cancer Registry and Histopathology Unit, ‘Civile M.P. Arezzo’ Hospital, ASP Ragusa, Italy;20. Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands;21. Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College, London, UK;22. National Institute for Public Health and the Environment, (RIVM), Bilthoven;23. Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, The Netherlands;24. Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø;25. Cancer Registry of Norway, Oslo, Norway;26. Department of Medical Epidemiology and Biostatistics, Stockholm, Sweden;27. Department of Genetic Epidemiology, Samfundet Folkhälsan, Helsinki, Finland;28. Public Health Directorate, Asturias;29. Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona;30. Andalusian School of Public Health, Granada;31. CIBER Epidemiología y Salud Pública (CIBERESP), Granada;32. Public Health Division of Gipuzkoa, Basque Government, San Sebastian;33. Navarre Public Health Institute, Pamplona;34. Department of Epidemiology, Murcia Regional Health Council, Murcia, Spain;35. Department of Health Sciences, Lund University, University Hospital, Malmö;36. Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg;37. Department of Surgical and Perioperative Sciences, Surgery and Public Health, Nutrition Research, University Umeå, Umeå;38. Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden;39. University of Cambridge, Cambridge;40. Medical Research Council – Epidemiology Unit, Cambridge;41. Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford;42. The School of Public Health, Imperial College London, London, UK;43. Nutritional Epidemiology, Institute of Nutritional and Food Science, University Bonn, Bonn;44. Section of Epidemiology, Institute of Experimental Medicine, Christian-Albrechts University of Kiel, Kiel, Germany |
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| Abstract: | BackgroundEvidence on associations between self-reported diabetes mellitus, diabetes duration, age at diabetes diagnosis, insulin treatment, and risk of biliary tract cancer (BTC) and hepatocellular carcinoma (HCC), independent of general and abdominal obesity is scarce.Patients and methodsWe conducted a prospective analysis in the EPIC-cohort study among 363 426 participants with self-reported diabetes data. Multivariable adjusted relative risks and 95% confidence intervals were estimated from Cox regression models. In a nested case–control subset, analyses were carried out in HCV/HBV-negative individuals.ResultsDuring 8.5 years of follow-up, 204 BTC cases including 75 gallbladder cancer (GBC) cases], and 176 HCC cases were identified. Independent of body mass index and waist-to-height ratio diabetes status was associated with higher risk of BTC and HCC 1.77 (1.00–3.13) and 2.17 (1.36–3.47)]. For BTC, the risk seemed to be higher in participants with shorter diabetes duration and those not treated with insulin. Regarding cancer subsites, diabetes was only associated with GBC 2.72 (1.17–6.31)]. The risk for HCC was particularly higher in participants treated with insulin. The results were not appreciably different in HCV/HBV-negative individuals.Conclusion(s)This study supports the hypothesis that diabetes is a risk factor for BTC (particularly GBC) and HCC. Further research is required to establish whether diabetes treatment or duration is associated with these cancers. |
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