Medical risk factors associated with cholangiocarcinoma in Taiwan: a population-based case-control study

PLoS One. 2013 Jul 22;8(7):e69981. doi: 10.1371/journal.pone.0069981. Print 2013.


Background: Cholangiocarcinoma, including intra- and extrahepatic cholangiocarcinoma, is a rare but highly lethal cancer. Despite effort in finding the risk factors of cholangiocarcinoma, the causes of most cholangiocarcinoma remain unknown. This study utilized a population-based case-control design using data from the National Health Insurance Research Database (NHIRD) of Taiwan to assess the medical conditions associated with cholangiocarcinoma.

Methods: 5,157 incident cases of cholangiocarcinoma diagnosed during 2004 to 2008 and 20,628 controls matched to the cases on sex, age, and time of diagnosis (reference date for the controls) were identified from the NHIRD. Medical risk factors were ascertained from the NHIRD for each individual. Conditional logistic regression was performed to evaluate the association between cholangiocarcinoma and each medical risk factor.

Results: The results showed that factors associated with an increased risk of cholangiocarcinoma included cholangitis, cholelithiasis, cholecystitis, cirrhosis of liver, alcoholic liver disease, chronic non-alcoholic liver disease, hepatitis B, hepatitis C, diabetes, chronic pancreatitis, inflammatory bowel disease, and peptic ulcer. In addition, sex and age differences were observed.

Conclusions: This study confirms the association between cholangiocarcinoma and several less established risk factors, including diabetes, inflammatory bowel disease, hepatitis B, hepatitis C, and peptic ulcer (proxy for the presence of Helicobacter Pylori). Future studies should focus on finding additional environmental and genetic causes of cholangiocarcinoma.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Distribution
  • Aged
  • Aged, 80 and over
  • Case-Control Studies
  • Cholangiocarcinoma / complications
  • Cholangiocarcinoma / epidemiology*
  • Cholangiocarcinoma / etiology
  • Female
  • Humans
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Organ Specificity
  • Risk Factors
  • Sex Distribution
  • Taiwan / epidemiology
  • Young Adult

Grant support

This study was supported by the Establishment of Cancer Research System Excellence Program funded by the Department of Health, Taiwan, R.O.C.; Grant number: DOH101-TD-C-111-004. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.