Risk Factor For Gallbladder Cancer Research Articles

Identification of Long Noncoding RNAs Expression Profiles Between Gallstone and Gallbladder Cancer Using Next-Generation Sequencing Analysis.

Gallstone disease (GS) is an important risk factor for Gallbladder cancer (GBC). However, the mechanisms of the progression of GS to GBC remain unclear. Long non-coding RNA (lncRNA), modulates DNA/RNA/proteins at epigenetic, pre-transcriptional, transcriptional and posttranscriptional levels, and plays a potential therapeutic role in various diseases. This study aims to identify lncRNAs that have a potential impact on GS-promoted GBC progression. Six GBC patients without GS, six normal gallbladder tissues, nine gallstones and nine GBC patients with GS were admitted to our hospital. The next-generation RNA-sequencing was performed to analyze differentially expressed (DE) lncRNA and messenger RNA (mRNA) in four groups. Then overlapping and specific molecular signatures were analyzed. We identified 29 co-DEGs and 500 co-DElncRNAs related to gallstone or GBC. The intersection and concatenation of co-DEGs and co-DElncRNA functionally involved in focal adhesion, Transcriptional misregulation in cancers, Protein digestion and absorption, and ECM-receptor interaction signaling pathways may contribute to the development of gallbladder cancer. Further exploration is necessary for early diagnosis and the potential treatment of GBC. FXYD2, MPZL1 and PAH were observed in both co-DEGs and co-DElncRNA and validated by qRT-PCR. Our data identified a series of DEGs and DElncRNAs, which were involved in the progression of GBC and GS-related metabolism pathways. Compared to GBC, the GS profile was more similar to para-tumor tissues in transcriptome level and lower risk of cancer. Further exploration is necessary from GBC patients with different periods of follow-up gallstone.

Gallbladder Cancer Incidentally Found at Cholecystectomy: Perioperative Risk Factors.

Risk factors of gallbladder cancer (GBC) are not well-defined resulting in greater than 60% of GBCs being diagnosed incidentally following cholecystectomy performed for presumed benign indications. As most localized GBCs require more extensive oncologic surgery beyond cholecystectomy, this study aims to examine factors associated with incidentally found GBC to improve preoperative and intraoperative diagnoses. The American College of Surgeons National Surgical Quality Improvement Program Database from 2007 to 2017 was used to identify cholecystectomies performed with and without a final diagnosis of GBC. Univariate and multivariable logistic regressions were used to compare demographic, intraoperative, and postoperative characteristics among those with and without a diagnosis of GBC. The incidence of GBC was observed to be 0.11% (441/403,443). Preoperative factors associated with risk of GBC included age > 60 (OR 6.51, p < .001), female sex (OR 1.75, p < .001), history of weight loss (2.58, p < .001), and elevated preoperative alkaline phosphatase level (OR 1.67, p = .001). Open approach was associated with 7 times increased risk of GBC compared to laparoscopic approach (OR 7.33, p < .001). In addition to preoperative factors and surgical approach, longer mean operative times (127min vs 70.7min, p < .001) were significantly associated with increased risk of GBC compared to benign final pathology. This study demonstrates that those with incidentally discovered GBC at cholecystectomy are unique from those undergoing cholecystectomy for benign indications. By identifying predictors of GBC, surgeons can choose high risk individuals for pre-operative oncologic evaluation and consider better tools for identifying GBC such as intraoperative frozen pathology.

Effect of mineral elements on the formation of gallbladder stones using spectroscopic techniques.

Long-standing gallbladder stones have been recognized as one of the highest risk factors for gallbladder cancer. However, the growth and progression of gallbladder stones are still not well-known, and their uncovering requires accurate information on the formation/nucleation and complex compositional information of gallstones. Multiple and single gallstones are analyzed using laser-induced breakdown spectroscopy (LIBS), photoacoustic spectroscopy (PAS), and Fourier transform infrared spectroscopy (FTIR). Spectral signatures as well as spatial variation in the spectral intensities of different elements are observed in the LIBS spectra of the gallstones. In the multiple-type gallstones, the concentration of inorganic content increases from core to periphery, whereas a single gallstone shows the opposite trend from the point of nucleation/core. It is suggested that the concentration of inorganic elements (Mg, Ca, K, and Na) plays an important role in the nucleation and growth of gallstones; thus, accordingly, multiple- and single-type gallstones are found in the gallbladder. The presence of different electronic bands of molecules, such as CH, C2, CN, and NH, is confirmed by LIBS and FTIR. PAS has identified molecules, such as cholesterol, calcium carbonate, and calcium phosphate, in different gallstone samples. These results show that PAS combined with LIBS is a promising candidate for the compositional analysis of gallstones. Furthermore, principal component analysis (PCA) is used to discriminate different layers present in the gallstones.

Horizontal duodenal papilla is associated with a special spectrum of pancreaticobiliary diseases: a retrospective magnetic resonance cholangiopancreatography-based study.

Horizontal duodenal papilla (HDP) is not an uncommon ectopic major papilla. The impact of HDP on the occurrence of pancreaticobiliary diseases remains unclear. Here, we explored the associations in patients who underwent magnetic resonance cholangiopancreatography (MRCP). Consecutive patients who underwent MRCP at Xijing Hospital (Xi'an, China) between January 2020 and December 2021 were eligible. Patients were divided into HDP and regular papilla (RP) according to the position of the major papilla. The primary outcome was the proportion of congenital pancreaticobiliary diseases. A total of 2,194 patients were included, of whom 72 (3.3%) had HDP. Compared with the RP group (n = 2,122), the HDP group had a higher proportion of congenital pancreaticobiliary diseases, especially choledochal cyst (CC) or anomalous pancreaticobiliary junction (APBJ) (6.9% vs 1.4%, P = 0.001). More gallbladder cancer (6.9% vs 1.2%, P < 0.001) and pancreatic cysts (27.8% vs 16.3%, P = 0.01) were also identified in the HDP group. Morphologically, the HDP group had a longer extrahepatic bile duct (8.4 [7.6-9.3] cm vs 7.2 [6.5-8.1] cm, P < 0.001), and larger angles between the common bile duct-duodenum and pancreatic duct-duodenum. Multivariate analysis showed that the presence of HDP was an independent risk factor for gallbladder cancer. This study confirmed that HDP was not rare in patients underwent MRCP. A higher prevalence of congenital pancreaticobiliary malformations (especially CC or APBJ), gallbladder cancer and pancreatic cysts was observed in patients with HDP, as well as distinctive morphologic features.

Chronic Exposure to Drinking Water Arsenic and Gallbladder Cancer Risk: Preliminary Evidence from Endemic Regions of India.

Evidence linking arsenic in drinking water to digestive tract cancers is limited. We evaluated the association between arsenic levels in groundwater and gallbladder cancer risk in a case-control study (2019-2021) of long-term residents (≥10years) in two arsenic-impacted and high gallbladder cancer risk states of India-Assam and Bihar. We recruited men and women aged 30 to 69 years from hospitals (73.4% women), with newly diagnosed, biopsy-confirmed gallbladder cancer (N = 214) and unrelated controls frequency-matched for 5-year age, sex, and state (N = 166). Long-term residential history, lifestyle factors, family history, socio-demographics, and physical measurements were collected. Average-weighted arsenic concentration (AwAC) was extrapolated from district-level groundwater monitoring data (2017-2018) and residential history. We evaluated gallbladder cancer risk for tertiles of AwAC (μg/L) in multivariable logistic regression models adjusted for important confounders [Range: 0-448.39; median (interquartile range), T1-0.45 (0.0-1.19); T2-3.75 (2.83-7.38); T3-17.6 (12.34-20.54)]. We observed a dose-response increase in gallbladder cancer risk based on AwAC tertiles [OR = 2.00 (95% confidence interval, 1.05-3.79) and 2.43 (1.30-4.54); Ptrend = 0.007]. Participants in the highest AwAC tertile consumed more tubewell water (67.7% vs. 27.9%) and reported more sediments (37.9% vs. 18.7%) with unsatisfactory color, odor, and taste (49.2% vs. 25.0%) than those in the lowest tertile. These findings suggest chronic arsenic exposure in drinking water at low-moderate levels may be a potential risk factor for gallbladder cancer. Risk factors for gallbladder cancer, a lethal digestive tract cancer, are not fully understood. Data from arsenic-endemic regions of India, with a high incidence of gallbladder cancer, may offer unique insights. Tackling 'arsenic pollution' may help reduce the burden of several health outcomes.

Association of nonsynonymous SNPs of nucleotide excision repair genes ERCC4 rs1800067 (G/A) and ERCC5 rs17655 (G/C) as predisposing risk factors for gallbladder cancer.

Deregulation of DNA repair mechanisms have been frequently demonstrated in the pathology of cancers including gallbladder cancer. We aimed to investigate the association of ERCC4 rs1800067 (G/A) and ERCC5 rs17655 (G/C) with the predisposition in gallbladder cancer and its prognosis. We have also investigated the prognostic and diagnostic values of expression profiles of ERCC4 and ERCC5 in GBC. Polymorphisms of rs1800067 and rs17655 were genotyped by PCR-RFLP. The expression of these genes was analyzed by semi-quantitative PCR. Overall survival was analyzed using Kaplan-Meier plot and cox-regression analysis. Patients with risk group genotypes of rs17655 have shorter overall survival in patients with presence of gallstone, T1+T2 tumor invasion, absence of lymph node involvement and early stages of tumor. Homozygous wild genotype (GG) of rs1800067 and homozygous mutant genotype (CC) of rs17655 together increases two-fold risk of the disease. The variant genotypes (GC/CC) of rs17655 show significantly higher level of ERCC5 expression. Major allele of ERCC4 rs1800067 and minor allele of ERCC5 rs17655 are significantly associated with increased risk of GBC. Upregulation of ERCC4 and ERCC5 is an early event of development of GBC.

Abstract 5888: Trends in incidence of gallbladder cancer in all 50 United States from 2001 to 2018

Abstract Background: Gallbladder cancer (GBC) is an aggressive malignancy of the gastrointestinal system that is historically more common among racial/ethnic minority populations in the US. We investigated trends in GBC incidence rates in all 50 states from 2001 to 2018, overall and stratified by race/ethnicity, sex, and different regions. Methods: Age-standardized incidence rates and trends in adults aged ≥35 years were calculated using data from the U.S. Cancer Statistics registry. We used joinpoint regression to compute annual percent changes (APC) and average annual percent changes (AAPC) and corresponding 95% confidence intervals (CI) for both sexes and used eleven 5-year age groups (35-39 years through 85+ years). Race/ethnic groups were classified as non-Hispanic Whites and Blacks (NHWs and NHBs), Hispanics, American Indians/Alaska Natives, and Asians and Pacific Islanders. Results: Overall, the age-standardized incidence rate for GBC decreased by 0.3% annually between 2001 and 2018 (95% CI -0.5%, -0.1%). However, secular trends varied by age-group, sex and race/ethnicity. APC increased among individuals aged 45-54 years from 1.2% to 1.4% but decreased among those who were ≥ 75 years (-0.7% to -1.6% per year). While GBC incidence rates were stable among men between 2001 and 2014, incidence rates decreased by over 2% per year between 2014 and 2018 (APC, -2.1%; 95%CI: -3.9, -0.3). GBC incidence remained relatively stable between 2001 and 2018 among women. While GBC rates declined in other racial/ethnic groups, the rates increased by 1.4% annually among non-Hispanic Blacks (NHBs) between 2001 and 2018 (APC=1.4%; 95%CI: 0.9%, 2.0%). Among NHBs, increasing trends were also noted in Northeast, Midwest, and South regions of US. Conclusions: The study shows increasing incidence trends for GBC in the US among NHBs from 2001-2018 compared to decreasing trends among other race/ethnic groups. The results also point to the need for studying equitable detection and treatment of underlying risk factors for GBC. Citation Format: Syed A. Raza, Wilson L. Costa, Aaron P. Thrift. Trends in incidence of gallbladder cancer in all 50 United States from 2001 to 2018 [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5888.

Insights From the Analysis of Clinicopathological and Prognostic Factors in Patients With Gallbladder Cancer.

AimsTo investigate the clinical efficacy and prognostic factors of primary gallbladder cancer (GBC) treated by radical surgery.MethodsThe clinical and pathological data of 168 patients with primary gallbladder cancer admitted and treated in the Third Affiliated Hospital of Soochow University from January 1st, 2010 to December 31st, 2018 were analyzed retrospectively. Kaplan Meier method was used to draw the survival curve and evaluate the survival rate. Chi-square test was used for univariate analysis and binary logistic regression was used for multivariate analysis.Results94 cases showed symptoms of abdominal pain and abdominal distension. 7 cases showed symptoms of fatigue and weight loss. Jaundice occurred in 10 patients. Fever occurred in 6 patients. 51 patients had no symptoms at all. The median survival time of 168 patients was 35.0 (1.0 ~ 142.0) months. The overall 1-, 2- and 3-year cumulative survival rates were 69.6%, 55.4% and 48.8% respectively. The univariate analysis indicated that preoperative bilirubin, tumor size, tumor location, pathological type, degree of differentiation, liver invasion, nerve invasion, vascular invasion, surgical margin, filtration depth and N staging were significant factors influencing prognosis of patients with primary GBC (P<0.05). The results of multivariate analysis demonstrated that degree of differentiation, nerve invasion, filtration depth and N staging were independent risk factors for prognosis of patients with primary GBC (P<0.05).ConclusionPatients with risk factors of gallbladder cancer should be more active in early cholecystectomy to avoid the malignant transformation of benign diseases. Degree of differentiation, nerve invasion, filtration depth and N staging were important factors for poor prognosis of patients with primary GBC. For T4 staging patients, preoperative evaluation should be more comprehensive, and patients and surgeons should be more prudent in adopting appropriate clinical treatment. The primary purpose should be prolonging the survival time and improving the quality of life.

Frequent promoter hypermethylation and down regulation of BNIP3: An early event during gallbladder cancer progression

BackgroundEpigenetic alterations have been reported as one of the risk factors of gallbladder cancer. Promoter hypermethylation is associated with high incidence and poor prognosis of GBC. Bcl-2/adenovirus E1B 19 kDa interacting protein 3 is a pro-apoptotic protein member of Bcl-2 family. AimsPresent study was aimed to investigate expression profile and promoter methylation status of BNIP3 in GBC and its correlation with clinico-pathological parameters. MethodsThe expression analysis and methylation status of BNIP3 was performed by semi-quantitative reverse transcription polymerase chain reaction and Methylation-specific polymerase chain reaction respectively in 84 GBC patients and 29 gallstone tissues (used as normal controls). ResultsWe demonstrate down regulation of BNIP3 in 56% of the GBC samples. BNIP3 promoter is also frequently hypermethylated (69%) in GBC samples. Interestingly, we found that 69% (40/58) of the BNIP3 promoter hypermethylated samples had also reduced expression of BNIP3. Our data demonstrate significant correlation of the mRNA expression and promoter hypermethylation with late stage and nodal metastasis. Hypermethylation of BNIP3 promoter is associated with low overall survival period. ConclusionOur results suggest that promoter hypermethylation is an early event and can be a frequent mechanism for downregulation of BNIP3 in GBC.

Assessment of Macro and Micronutrient Levels Associated with Gallbladder Cancer among Women of Eastern Uttar Pradesh and Western Bihar: A Case-control Study

Introduction: Gallbladder Cancer (GBC) is highly fatal due to late-stage diagnosis and poor prognosis. Women are more prone to GBC than men. Imbalanced nutrient intake is cited as a risk factor for GBC. Association of nutrients with GBC incidence assessed using 24-hour recall method may mislead as food intake is altered in disease condition. The Food Frequency Questionnaire (FFQ) method that assesses usual nutrient intake pattern would be a better approach. Aim: To evaluate the association of macro and micronutrients in women with GBC using the FFQ method. Materials and Methods: This case-control study was carried out at a tertiary care hospital of Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India, from September 2018 to August 2019. A total of 82 women with GBC, aged 40 years and above, considered as cases and 164 healthy controls were included in the study. Data was collected regarding food intake, following the FFQ method, which included breakfast, lunch, dinner, and other extra intakes. Macro and micronutrients were computed using a raw database of food. A multivariate statistical approach was adopted as the nutrients were correlated. Results: The mean age of the controls (45.7±10.1 years) was significantly lower than the GBC cases (55.2±11.0 years). Preponderance in both cases and controls was of Hindus, rural and Other Backward Class (OBC) women. Illiterate patients were more than twice than the controls. Intake of 12 nutrients i.e., protein, fat, phosphorus, zinc, manganese, and carotene were higher and of calcium, potassium, selenium, vitamin-C, vitamin-E, and fibre were lower in cases than the controls. These 12 nutrients completely separated cases and controls. However, zinc, manganese, potassium, and fibre whose contributions were lowest when ignored, the separation ability to cases and controls remained the same as of 12 nutrients. Conclusion: Protein, fat, phosphorus, carotene, calcium, selenium, vitamin-C and vitamin-E, were found to be associated with GBC risk. Therefore, further understanding the role of nutrients in bringing about the right intervention to reduce the incidence of GBC is needed.

MCL1 participates in leptin-promoted mitochondrial fusion and contributes to drug resistance in gallbladder cancer.

Obesity is a risk factor for gallbladder cancer (GBC) development, and it correlates with shorter overall survival. Leptin, derived from adipocytes, has been suggested to contribute to the growth of cancer cells; however, the detailed mechanism of leptin in GBC drug resistance remains uninvestigated. In this study, our finding that patients with GBC with a higher BMI were associated with increased GBC risks, including shortened survival, is clinically relevant. Moreover, obese NOD/SCID mice exhibited a higher circulating concentration of leptin, which is associated with GBC growth and attenuated gemcitabine efficacy. We further revealed that leptin can inhibit gemcitabine-induced GBC cell death through myeloid cell leukemia 1 (MCL1) activation. The transcription factor C/EBP δ (CEBPD) is responsive to activated STAT3 (pSTAT3) and contributes to MCL1 transcriptional activation upon leptin treatment. In addition, MCL1 mediates leptin-induced mitochondrial fusion and is associated with GBC cell survival. The findings in this study suggest the involvement of the pSTAT3/CEBPD/MCL1 axis in leptin-induced mitochondrial fusion and survival and provide a potentially new therapeutic target to improve the efficacy of gemcitabine in patients with GBC.

Association of Microbial Dysbiosis with Gallbladder Diseases Identified by Bile Microbiome Profiling.

BackgroundCholecystitis is an important risk factor for gallbladder cancer, but the bile microbiome and its association with gallbladder disease has not been investigated fully. We aimed to analyze the bile microbiome in normal conditions, chronic cholecystitis, and gallbladder cancer, and to identify candidate bacteria that play an important role in gallbladder carcinogenesis.MethodsWe performed metagenome sequencing on bile samples of 10 healthy individuals, 10 patients with chronic cholecystitis, and 5 patients with gallbladder cancer, and compared the clinical, radiological, and pathological characteristics of the participants.ResultsNo significant bacterial signal was identified in the normal bile. The predominant dysbiotic bacteria in both chronic cholecystitis and gallbladder cancer were those belonging to the Enterobacteriaceae family. Klebsiella increased significantly in the order of normal, chronic cholecystitis, and gallbladder cancer. Patients with chronic cholecystitis and dysbiotic microbiome patterns had larger gallstones and showed marked epithelial atypia, which are considered as precancerous conditions.ConclusionWe investigated the bile microbiome in normal, chronic cholecystitis, and gallbladder cancer. We suggest possible roles of Enterobacteriaceae, including Klebsiella, in gallbladder carcinogenesis. Our findings reveal a possible link between a dysbiotic bile microbiome and the development of chronic calculous cholecystitis and gallbladder cancer.

Risk factors for gallbladder cancer

Introduction and purpose: Gallbladder cancer is the most common neoplasm of the bile duct. Early GBC is usually asymptomatic, but is prone to early metastases. This means that most GBC cases are diagnosed very late, and this contributes to the poor prognosis of this disease. Less than 20% of GBC cases qualify for a potentially curable surgical resection at the moment of diagnosis. The article is an overview of available literature describing current epidemiology and etiological risk factors associated with the development of gallbladder cancer (GBC). We performed a review of the articles on the etiology and GBC carcinomatosis.Brief description of the state of knowledge: We divided risk factors of GBC into independent and dependent. The independent risk factors are: age, sex, cholelithiasis, porcelain gallbladder, gallbladder polyp, anomalous junction of the pancreaticobiliary ductal system, high BMI and obesity, and Helicobacter pylori. On the other hand, the dependent risk factors are: age of first pregnancy and number of pregnancies, xanthogranulomatous cholecystitis, lipid peroxidation products, and aflatoxins. Gallbladder cancer appears to be a multifactorial disease, but the main risk factors are: cholelithiasis and porcelain gallbladder developing from chronic cholecystitis.Conclusions: For understanding the etiopathology of GBC more studies have to be conducted, what may allow to establish reliable biomarkers and invent new preventive strategies and more effective treatment.

Evaluation of the chemopreventive potentials of ezetimibe and aspirin in a novel mouse model of gallbladder preneoplasia.

Gallbladder stones (cholecystolithiasis) are the main risk factor for gallbladder cancer (GBC), a lethal biliary malignancy with poor survival rates worldwide. Gallbladder stones are thought to damage the gallbladder epithelium and trigger chronic inflammation. Preneoplastic lesions that arise in such an inflammatory microenvironment can eventually develop into invasive carcinoma, through mechanisms that are not fully understood. Here, we developed a novel gallbladder preneoplasia mouse model through the administration of two lithogenic diets (a low- or a high-cholesterol diet) in wild-type C57BL/6 mice over a period of 9months. Additionally, we evaluated the chemopreventive potentials of the anti-inflammatory drug aspirin and the cholesterol absorption inhibitor ezetimibe. Both lithogenic diets induced early formation of gallbladder stones, together with extensive inflammatory changes and widespread induction of metaplasia, an epithelial adaptation to tissue injury. Dysplastic lesions were presented only in mice fed with high-cholesterol diet (62.5%) in late stages (9th month), and no invasive carcinoma was observed at any stage. The cholesterol absorption inhibitor ezetimibe inhibited gallbladder stone formation and completely prevented the onset of metaplasia and dysplasia in both lithogenic diets, whereas aspirin partially reduced metaplasia development only in the low-cholesterol diet setting. This model recapitulates several of the structural and inflammatory findings observed in human cholecystolithiasic gallbladders, making it relevant for the study of gallbladder carcinogenesis. In addition, our results suggest that the use of cholesterol absorption inhibitors and anti-inflammatory drugs can be evaluated as chemopreventive strategies to reduce the burden of GBC among high-risk populations.

Identification of UBE2T as an independent prognostic biomarker for gallbladder cancer.

Gallbladder cancer is the most common biliary tract malignant tumor, with unfavorable patient outcomes. The present study aimed to identify potential diagnostic or prognostic biomarkers for gallbladder cancer. To do so, differentially expressed genes in the gallbladder walls and tumor tissues of patients with gallbladder cancer were analyzed via microarray. Furthermore, a protein-protein interaction network was constructed and genes with a degree score >10 were selected as hub genes. As ubiquitin conjugating enzyme E2T (UBE2T) was considered to be a hub gene, its expression was assessed via reverse transcription-quantitative (RT-q)PCR and immunohistochemistry (IHC). In addition, the association between UBE2T expression and the clinicopathological characteristics of patients with gallbladder cancer was analyzed using the χ2 test. Furthermore, all patients were divided into high- and low groups based on UBE2T expression level and overall survival analysis was performed. Univariate and multivariate Cox regression analyses were performed to determine whether UBE2T may serve as an independent risk factor for gallbladder cancer. The results demonstrated that UBE2T expression was upregulated in the gallbladder walls and tumor tissues of patients with gallbladder cancer. Furthermore, UBE2T expression level was confirmed to be upregulated following RT-qPCR, and results from IHC demonstrated that UBE2T was predominantly expressed in the cytoplasm of gallbladder cancer cells. In addition, high UBE2T expression level was associated with clinical stage, T classification, N classification and M classification. The results from Univariate and multivariate analyses indicated that UBE2T expression level may be considered as an independent risk factor for gallbladder cancer. Taken together, the findings from this study suggested that high UBE2T expression level may contribute to the poor prognosis of patients with gallbladder cancer, and that UBE2T may act as an independent prognostic biomarker for these patients.

A clinical epidemiological study of gallbladder carcinoma: a retrospective study

Background: Incidence of gallbladder carcinoma (GBC) is high among the north Indian population. It may be due to environmental, dietary and reproductive factors. Evaluation of GBC epidemiology will provide important insights into determining causes and risk factors for gallbladder cancer. The aims and objectives were to study the epidemiology, clinical presentation and etiological factors of GBC.Methods: Fifty-one cases of GBC were studied retrospectively at Cancer Hospital and Research Institute (CHRI) Gwalior, Madhya Pradesh, India from January to December 1998. All the patients underwent a detailed history taking and physical examination followed by routine laboratory tests and other investigations including ultrasonographic and computed tomography scan of whole abdomen. Histopathological evaluation of gallbladder specimen was also performed after surgical resection of the GB mass.Results: Incidence of GBC at this centre was 1.49%. GBC was more prevalent among old women (mean age 52.62±12.14 years) belonging to low socio-economic status (SES) (52.94%). Most common presenting symptom of GBC was pain in right hypochondrium (70.4%) followed by anorexia (42.8%), pruritus (35.7%), weight loss (31.2), nausea and vomiting (30.4%). Histopathological examination revealed majority of the case to have adenocarcinoma (84.31%). Gallstones were present in 35.29% patients.Conclusions: GBC is more prevalent in older women belonging to low SES. Gallstones remain the chief risk factor for this malignancy. Histopathological examination of all cholecystectomy specimens for early pre cursor lesion could serve as an important means of early detection of this carcinoma.

Aspirin and statin use and the risk of gallbladder cancer.

243 Background: The risk factors for gallbladder cancer (GBC) are poorly understood and preventive therapeutic options have not been identified. The use of aspirin (ASA) and/or statin has been associated with reduced risk of several gastrointestinal cancers. In this study, we explore if the use of ASA or statin is associated with a reduced risk of GBC. Methods: We identified patients with GBC diagnosed between the years 2000 and 2016 at Mayo Clinic. We identified matched controls in 2:1 fashion for age, gender and country of residence from patients who underwent cholecystectomy at Mayo Clinic. We collected information on co-morbidities and use of statins or ASA by retrospective chart review. We compared baseline characteristics between cases and controls using Fisher’s exact test for categorical variables and Mann-Whitney U test for continuous variables. We used binomial logistic regression to calculate the odds ratio (OR) and 95% confidence intervals (CI) to estimate the association of ASA or statin use with GBC. The logistic regression model included history of cholelithiasis, diabetes, hypercholesterolemia (HCL), hypertension (HTN), hyperthyroidism, hypothyroidism, primary sclerosing cholangitis (PSC), inflammatory bowel disease (IBD), cirrhosis and statin or ASA use as covariates. Results: 633 cases and 1,266 controls were included in our final analysis. The median age at diagnosis of cases and controls was 67 years. The control group had a significantly (p &lt; 0.05) higher proportion of patients with cholelithiasis, HCL, HTN, hypothyroidism and liver cirrhosis compared to the cases. The case group,contrarily, had a significantly higher proportion of patients with PSC and IBD. In univariate analysis, ASA (OR: 0.41; 95% CI: 0.33-0.52) or statin (OR: 0.48; 95% CI: 0.38-0.60) use was associated with a lower risk of GBC (p &lt; 0.001). However, in multivariate analysis, ASA use was associated with a lower risk of GBC (OR: 0.52; 95% CI: 0.41-0.67, p &lt; 0.001) whereas statin use was not (OR: 0.76; 95% CI: 0.56-1.03, p = 0.08). Conclusions: Our study demonstrates that aspirin use is associated with a reduced risk of GBC, whereas statin use is not. Further studies on GBC are needed to confirm these results and to elucidate mechanisms that explain the risk reduction with aspirin.

Detection and quantification of heavy metal elements in gallstones using X‐ray fluorescence spectrometry

Gallbladder cancer, which is associated with the heavy metal toxicity, is one of the most dangerous malignancies. High occurrence of gallstones in the gallbladder is a well‐recognized risk factor for gallbladder cancer. Accumulation of heavy and toxic metals in the biliary system is one of the main causes of gallstone formation and leads to gallbladder cancer if it remains untreated. In this work, we investigate heavy and toxic metals in gallstones to identify their association as potential risk factors for gallbladder cancer. Detection and quantification of the heavy and toxic chemicals present in gallstones are important to define etiopathogenic factors that, in turn, are useful to identify preventive and therapeutic strategies. We quantified the heavy metals in gallstones collected from patients of different age groups and dietary habits. We carried out chemical composition studies of trace and heavy metal elements present in gallstones by applying Fourier transform infrared (FTIR) spectroscopy and wavelength‐dispersive X‐ray fluorescence (WD‐XRF) spectrometry. We also compared our experimental results with the results obtained from atomic absorption spectroscopy, as well as values previously reported in literature. These findings demonstrate the potential of WD‐XRF spectrometry and FTIR spectroscopy as important emerging diagnostic tools in the field of gastroenterology.

Epidemiology and risk factors of gallbladder cancer

Epidemiology and risk factors of gallbladder cancer

Epidemiology and Risk Factors of Gallbladder Cancer

Epidemiology and Risk Factors of Gallbladder Cancer