Significant Differences in Risk Factors for Perihilar Cholangiocarcinoma (CCA) Compared to Distal CCA: Rationale for Approaching Them as Distinct Entities.

Slides:

Advertisements

Similar presentations

Update on Cholangiocarcinoma: What we have learned from the International Hepatobiliary Neoplasia Biorepository Roon Chaiteerakij, MD Mayo Clinic, Rochester,

Advertisements

Is low-dose Aspirin use associated with a reduced risk of colorectal cancer ? a QResearch primary care database analysis Prof Richard Logan, Dr Yana Vinogradova,

Body Weight and Mortality: New Population Based Evidences Body Weight and Mortality: New Population Based Evidences Dongfeng Gu, MD Dongfeng Gu, MD Fu.

Asymptomatic UC patients on an immunomodulator with persistent moderate mucosal inflammation should either add a biologic or switch to a biologic William.

Colonoscopic surveillance for prevention of colorectal cancer in people with ulcerative colitis, Crohn’s disease or adenomas NICE CG March 2011.

Preventive Health Care Use in Elderly Uterine Cancer Survivors Division of Health Policy and Management School of Public Health University of Minnesota.

1 Journal Club Alcohol, Other Drugs, and Health: Current Evidence January–February 2014.

Oral Bisphosphonate and Breast Cancer: Prospective Results from the Women’s Health Initiative (WHI) Chlebowski RT et al. SABCS 2009; Abstract 21.

Effect of Hypertension and Dyslipidemia on glycemic control among Type 2 Diabetes patients in Thailand Dr. Mya Thandar Dr.PH. Batch 5 1.

Obtaining housing associated with achieving abstinence after detoxification in adults with addiction Tae Woo Park, Christine Maynié-François, Richard Saitz.

Immunomodulation of Regional Citrate Anticoagulation in Acute Kidney Injury Requiring Renal Replacement Therapy Sasipha Tachaboon 1, Khajohn Tiranatanakul.

Gastroenterology Grand Rounds

Bigger Waist Means Higher Asthma Risk Summary and Comment by Wendy S. Biggs, MD Published in Journal Watch Women's Health September 24, 2009Journal Watch.

1 CONFIDENTIAL – DO NOT DISTRIBUTE ARIES mCRC: Effectiveness and Safety of 1st- and 2nd-line Bevacizumab Treatment in Elderly Patients Mark Kozloff, MD.

The Nutrition Transition Program The University of North Carolina at Chapel Hill Ethnic Differences in the Association Between Body Mass Index and Hypertension.

Carina Signori, DO Journal Club August 2010 Macdonald, M. et al. Diabetes Care; Jun 2010; 33,

The Natural History of Liver Fibrosis Progression Rate in Hepatitis C Infection David Yamini, Benjamin Basseri, Anush Arakelyan, Pedram Enayati, Tram T.

Clinicaloptions.com/hepatitis NAFLD and NASH Prevalence in US Cohort Slideset on: Williams CD, Stengel J, Asike MI, et al. Prevalence of nonalcoholic fatty.

Reducing Tobacco Intake Lowers Risk of Lung Cancer in Heavy Smokers Slideset on: Godtfredsen NS, Prescott E, Osler M. Effect of smoking reduction on lung.

High frequency of early colorectal cancer in inflammatory bowel disease M W M D Lutgens, F P Vleggaar, M E I Schipper, P C F Stokkers, C J van der Woude,

When Using DOPPS Slides. DOPPS Slide Use Guidelines.

Hashem B. El-Serag,1,2 Eric A. Engels,3 Ola Landgren,3 Elizabeth Chiao,1,2 Louise Henderson,1,2 Harshinie C. Amaratunge,1,2 and Thomas P. Giordano1,2 R1.

Inflammatory Bowel Disease Is Associated With an Increased Incidence of Cardiovascular Events Andres J. Yarur, MD, Amar R. Deshpande, MD, David M. Pechman,

CERAD immediate memory verbal fluency (animals)

Paid employment and Common Mental Disorders (CMD) in the UK

A new preoperative Severity Scoring System For Acute Cholecystitis

Opiate use in patients with inflammatory bowel disease

Work disability in inflammatory bowel disease

Inflammatory Bowel Disease (IBD) is a Risk Factor for Extrahepatic Cholangiocarcinoma (ECC) in Subjects Without Underlying Primary Sclerosing Cholangitis.

PATIENT ACTIVATION IN INFLAMMATORY BOWEL DISEASE PATIENTS

Ulcerative Colitis (UC)-Associated Colorectal Cancer (CRC) Patients Who Receives Colorectal Surgery More Likely Receive Blood Transfusion Than Crohn’s.

Mayo Clinic College of Medicine

Viktor Oskarsson,1 Caroline Nordenvall,2 and Alicja Wolk1

Cholangiocarcinoma Tamar Taddei, MD.

Alcohol, Other Drugs, and Health: Current Evidence March–April 2017

Assessing the effect of cesarean section on Crohn’s Disease

1 Patient enrollment flow chart.

patients with Parkinson’s disease

J.Livie1, E.Goodall1, M.Wilson2,C.Payne2 Department of Surgery2

Clinical Correlates of Mental Health Issues in Outpatients with Inflammatory Bowel Disease under Routine Care Taryn Lores Health Psychologist, IBD Service.

Proposal of a simplified treatment algorithm in patients with cancer and liver cirrhosis. 1 Both tumour- and liver-related prognosis should be taken into.

Presenter: Wen-Ching Lan Date: 2018/08/01

Bronx Community Health Dashboard: Colorectal Cancer Created: 12/22/2017 Last Updated: 01/19/2018 See last slide for more information about.

Coffee drinking and leukocyte telomere length: A meta-analysis

Classification, Diagnosis, and Management of Cholangiocarcinoma

ASCEND Randomized placebo-controlled trial of aspirin 100 mg daily in 15,480 patients with diabetes and no baseline cardiovascular disease Jane Armitage.

Basics of PSC Christopher L. Bowlus, MD

Pregnancy in Primary Sclerosing Cholangitis

Alcohol control laws, inequalities and geographical clusters of hazardous alcohol use in Geneva, Switzerland José Luis Sandoval1,2,3, Teresa Leão4, Rebecca.

Creatinine clearance in cases and controls

Nat. Rev. Gastroenterol. Hepatol. doi: /nrgastro

Franklin SS, et al. Circulation 2009;119:243-50

Volume 138, Issue 5, Pages e2 (May 2010)

Clinical outcome after SVR: ANRS CO22 HEPATHER

Update on Biomarkers of Hepatocellular Carcinoma

Clinical features of bowel disease in patients aged

Suzanne M. Dolwick Grieb, MSPH: University of Florida (UF)

Eligibility criteria for inclusion as an expert Delphi panellist

Evaluation of the Patient-Reported Outcomes Measurement Information System in a Large Cohort of Patients With Inflammatory Bowel Diseases Michael D.

Risk of Cancer in Patients With Inflammatory Bowel Diseases: A Nationwide Population- based Cohort Study With 30 Years of Follow-up Evaluation Michael.

Meenakshi Bewtra, Chinyu Su, James D. Lewis

Figure 2 Classifications and appearance of CCAs

Incidence of HCC after HCV treatment with DAAs: ERCHIVES

Cancer is not a risk factor for bullous pemphigoid

Respondent suggestions as to how best to protocol case selection for the inflammatory bowel disease (IBD) multidisciplinary team (MDT)—application of an.

Risk factors for postoperative infection after lower gastrointestinal surgery in patients with inflammatory bowel disease: Findings from a large epidemiological.

Cox regression analysis of the proportion of patients remaining in remission during azathioprine treatment related to diagnosis of inflammatory bowel disease.

Cox regression analysis of the proportion of patients remaining in remission after stopping azathioprine treatment related to diagnosis of inflammatory.

Odds ratio (95% confidence intervals) of reporting respiratory symptoms in patients with treated hypothyroidism or inflammatory bowel disease (IBD) compared.

Nat. Rev. Clin. Oncol. doi: /nrclinonc

Presentation transcript:

Significant Differences in Risk Factors for Perihilar Cholangiocarcinoma (CCA) Compared to Distal CCA: Rationale for Approaching Them as Distinct Entities Hassan M. Ghoz1, Esha Baichoo1, Benyam Addissie 1, Lewis R. Roberts1, Roongruedee Chaiteerakij2 1Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA 2Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand Background Baseline Characteristics of Study Cohort Multivariate Analysis of Potential Risk Factors for pCCA Summary and Conclusions Although perihilar (pCCA) and distal (dCCA) share some commonalities and are often grouped as extrahepatic cholangiocarcinoma (ECC), growing evidence suggests that they are separate diseases. Whether the risk factors for pCCA and dCCA are the same is controversial. Gallstones are associated with an increased risk for CCA. It is unclear whether the risk of pCCA and dCCA declines to the baseline population risk level after a cholecystectomy. 1. The risk factors for pCCA and dCCA were different. 2. HCV, cirrhosis, and diabetes were associated with pCCA risk only. 3. Smoking, PSC, IBD, and gallstones were common risk factors for pCCA and dCCA. 4. Cholecystectomy attenuated the risk for pCCA but the risk remained higher than for the general population. This risk reduction was not observed with dCCA. 5. Our results support the proposal that pCCA and dCCA are separate entities. Variables pCCA dCCA Cases (n=524) Controls (n=1033) (n=112) (n=221) Age, year 62.4 ± 14.0 62.5 ± 14.0 66.3 ± 12.2 66.4 ± 14.0 Male, n (%) 316 (60.3) 620 (60.0) 71 (63.4) 138 (62.4) White, n (%) 459 (87.6) 925 (89.5) 101 (90.2) 204 (92.3) Risk factors, n (%) Smoking 237 (45.2) 413 (40.5) 65 (58.0) 90 (41.3) Alcohol 283 (54.0) 799 (77.7) 70 (62.5) 169 (76.4) BMI (>30 kg/m2) 131 (25.0) 254 (26.0) 35 (31.3) 73 (34.1) PSC* 113 (21.6) 1 (0.01) 9 (8.0) 0 (0) Diabetes 73 (13.9) 105 (10.4) 24 (21.4) 29 (13.0) Inflammatory Bowel Disease (Combined) 99 (18.9) 21 (2.0) 12 (10.7) 1 (0.5) Ulcerative Colitis 78 (14.9) 13 (1.3) 10 (8.9) Crohn’s Disease 21 (4.0) 8 (0.7) 2 (1.8) Cirrhosis 28 (5.3) 5 (0.5) HCV 9 (1.7) 4 (0.4) 2 (0.9) HBV 5 (1) Incidental Asymptomatic Gallstones 65 (12.4) 23 (2.2) 14 (12.5) 5 (2.3) Cholecystectomy for Gallstones 5 (2.26) Choledochal Cyst 3 (0.6) 1 (0.9) Variables AOR(95%CI) P-value 0.3 (0.2-0.5) <0.0001 1.5 (1.0-2.1) 0.03 1.6 (1.2-2.0) <0.0003 1.8 (0.9-3.6) 0.11 3.3 (1.1-11.1) 0.04 4.5 (1.3-17.8) 0.02 8.9 (5.5-15.1) 225 (47.0 - 4.0x103) iCCA pCCA dCCA Methods Adjusted Odds Ratio (AOR) Multivariate Analysis of Potential Risk Factors for dCCA References 1. Tyson, G. L. and H. B. El-Serag (2011). "Risk factors for cholangiocarcinoma." Hepatology 54(1): 173-184. 2. Nordenstedt, H., F. Mattsson, et al. (2012). "Gallstones and cholecystectomy in relation to risk of intra- and extrahepatic cholangiocarcinoma." British journal of cancer 106(5): 1011-1015. Variables AOR(95%CI) P-value 1.5 (1.5- 4.1) 0.0005 5.7 (1.9-19.4) 0.002 11.3 (1.6-226.2) 0.01 3.9X107 0.0006 Acknowledgments * PSC: Primary sclerosing cholangitis Objectives To compare the risk factors for pCCA and dCCA To evaluate the decrease in risk of CCA post-cholecystectomy Adjusted Odds Ratio (AOR) © 2014 Mayo Foundation for Medical Education and Research