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Stepien, M., Hughes, D. J., Hybsier, S., Bamia, C., Tjønneland, A., Overvad, K., . . . Jenab, M. (2017). Circulating copper and zinc levels and risk of hepatobiliary cancers in Europeans. British Journal of Cancer, 116(5), 688-696
Open this publication in new window or tab >>Circulating copper and zinc levels and risk of hepatobiliary cancers in Europeans
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2017 (English)In: British Journal of Cancer, ISSN 0007-0920, E-ISSN 1532-1827, Vol. 116, no 5, p. 688-696Article in journal (Refereed) Published
Abstract [en]

Background: Copper and zinc are essential micronutrients and cofactors of many enzymatic reactions that may be involved in liver-cancer development. We aimed to assess pre-diagnostic circulating levels of copper, zinc and their ratio (Cu/Zn) in relation to hepatocellular carcinoma (HCC), intrahepatic bile duct (IHBD) and gall bladder and biliary tract (GBTC) cancers. Methods: A nested case-control study was conducted within the European Prospective Investigation into Cancer and Nutrition cohort. Serum zinc and copper levels were measured in baseline blood samples by total reflection X-ray fluorescence in cancer cases (HCC n = 106, IHDB n = 34, GBTC n = 96) and their matched controls (1: 1). The Cu/Zn ratio, an indicator of the balance between the micronutrients, was computed. Multivariable adjusted odds ratios and 95% confidence intervals (OR; 95% CI) were used to estimate cancer risk. Results: For HCC, the highest vs lowest tertile showed a strong inverse association for zinc (OR = 0.36; 95% CI: 0.13-0.98, Ptrend = 0.0123), but no association for copper (OR = 1.06; 95% CI: 0.45-2.46, Ptrend = 0.8878) in multivariable models. The calculated Cu/ Zn ratio showed a positive association for HCC (OR = 4.63; 95% CI: 1.41-15.27, Ptrend = 0.0135). For IHBC and GBTC, no significant associations were observed. Conclusions: Zinc may have a role in preventing liver-cancer development, but this finding requires further investigation in other settings.

Place, publisher, year, edition, pages
NATURE PUBLISHING GROUP, 2017
Keywords
copper, zinc, hepatocellular carcinoma, prospective cohort, nested case-control study, cancer risk factors
National Category
Public Health, Global Health, Social Medicine and Epidemiology Cancer and Oncology
Identifiers
urn:nbn:se:umu:diva-133525 (URN)10.1038/bjc.2017.1 (DOI)000395696200017 ()28152549 (PubMedID)
Available from: 2017-05-15 Created: 2017-05-15 Last updated: 2018-06-09Bibliographically approved
Efe, C., Hagström, H., Ytting, H., Bhanji, R. A., Müller, N. F., Wang, Q., . . . Wahlin, S. (2017). Efficacy and Safety of Mycophenolate Mofetil and Tacrolimus as Second-line Therapy for Patients With Autoimmune Hepatitis. Clinical Gastroenterology and Hepatology, 15(12), 1950-1956
Open this publication in new window or tab >>Efficacy and Safety of Mycophenolate Mofetil and Tacrolimus as Second-line Therapy for Patients With Autoimmune Hepatitis
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2017 (English)In: Clinical Gastroenterology and Hepatology, ISSN 1542-3565, E-ISSN 1542-7714, Vol. 15, no 12, p. 1950-1956Article in journal (Refereed) Published
Abstract [en]

BACKGROUND & AIMS: Predniso(lo) ne, alone or in combination with azathioprine, is the standard-of-care (SOC) therapy for autoimmune hepatitis (AIH). However, the SOC therapy is poorly tolerated or does not control disease activity in up to 20% of patients. We assessed the efficacy of mycophenolate mofetil (MMF) and tacrolimus as second-line therapy for patients with AIH. METHODS: We performed a retrospective study of data (from 19 centers in Europe, the United States, Canada, and China) from 201 patients with AIH who received second-line therapy (121 received MMF and 80 received tacrolimus), for a median of 62 months (range, 6-190 mo). Patients were categorized according to their response to SOC. Patients in group 1 (n = 108) had a complete response to the SOC, but were switched to second-line therapy as a result of side effects of predniso(lo) ne or azathioprine, whereas patients in group 2 (n = 93) had not responded to SOC. RESULTS: There was no significant difference in the proportion of patients with a complete response to MMF (69.4%) vs tacrolimus (72.5%) (P = .639). In group 1, MMF and tacrolimus maintained a biochemical remission in 91.9% and 94.1% of patients, respectively (P = .682). Significantly more group 2 patients given tacrolimus compared with MMF had a complete response (56.5% vs 34%, respectively; P = .029) There were similar proportions of liver-related deaths or liver transplantation among patients given MMF (13.2%) vs tacrolimus (10.3%) (log-rank, P = .472). Ten patients receiving MMF (8.3%) and 10 patients receiving tacrolimus (12.5%) developed side effects that required therapy withdrawal. CONCLUSIONS: Long-term therapy with MMF or tacrolimus generally was well tolerated by patients with AIH. The agents were equally effective in previous complete responders who did not tolerate SOC therapy. Tacrolimus led to a complete response in a greater proportion of previous nonresponder patients compared with MMF.

Place, publisher, year, edition, pages
Elsevier, 2017
Keywords
Autoimmune Liver Disease, Simplified Criteria, Liver Failure, Liver Transplantation
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:umu:diva-142448 (URN)10.1016/j.cgh.2017.06.001 (DOI)000415165200027 ()28603052 (PubMedID)
Available from: 2017-12-05 Created: 2017-12-05 Last updated: 2018-06-09Bibliographically approved
Danielsson Borssén, Å., Marschall, H.-U., Bergquist, A., Rorsman, F., Weiland, O., Kechagias, S., . . . Werner, M. (2017). Epidemiology and causes of death in a Swedish cohort of patients with autoimmune hepatitis. Scandinavian Journal of Gastroenterology, 52(9), 1022-1028
Open this publication in new window or tab >>Epidemiology and causes of death in a Swedish cohort of patients with autoimmune hepatitis
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2017 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 52, no 9, p. 1022-1028Article in journal (Refereed) Published
Abstract [en]

Background: Epidemiological studies of autoimmune hepatitis (AIH) show varying figures on prevalence and incidence, and data on the long-term prognosis are scarce.

Objective To investigate the epidemiology, long-term prognosis and causes of death in a Swedish AIH cohort.

Material and methods: Data collected from 634 AIH patients were matched to the Cause of Death Registry, and survival analyses were made. Prevalence and incidence were calculated for university hospitals with full coverage of cases and compared to the County of Vasterbotten in Northern Sweden.

Results: AIH point prevalence was 17.3/100,000 inhabitants in 2009, and the yearly incidence 1990-2009 was 1.2/100,000 inhabitants and year. The time between diagnosis and end of follow-up, liver transplantation or death was in median 11.3 years (range 0-51.5 years). Men were diagnosed earlier (p<.001) and died younger than women (p=.002). No gender differences were found concerning transplant-free, overall survival and liver-related death. Cirrhosis at diagnosis was linked to an inferior survival (p<.001). Liver-related death was the most common cause of death (32.7%). The relative survival started to diverge from the general population 4 years after diagnosis but a distinct decline was not observed until after more than 10 years.

Conclusions: Long-term survival was reduced in patients with AIH. No gender difference regarding prognosis was seen but men died younger, probably as a result of earlier onset of disease. Cirrhosis at diagnosis was a risk factor for poor prognosis and the overall risk of liver-related death was increased.

Keywords
Autoimmune hepatitis, epidemiology, causes of death, liver, cirrhosis
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-137902 (URN)10.1080/00365521.2017.1335772 (DOI)000404368000016 ()28562110 (PubMedID)
Available from: 2017-07-26 Created: 2017-07-26 Last updated: 2018-06-09Bibliographically approved
Danielsson Borssén, Å., Palmqvist, R., Kechagias, S., Marschall, H.-U., Bergquist, A., Rorsman, F., . . . Werner, M. (2017). Histological improvement of liver fibrosis in well-treated patients with autoimmune hepatitis: a cohort study. Medicine (Baltimore, Md.), 96(34), Article ID e7708.
Open this publication in new window or tab >>Histological improvement of liver fibrosis in well-treated patients with autoimmune hepatitis: a cohort study
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2017 (English)In: Medicine (Baltimore, Md.), ISSN 0025-7974, E-ISSN 1536-5964, Vol. 96, no 34, article id e7708Article in journal (Refereed) Published
Abstract [en]

Objectives Autoimmune hepatitis (AIH) is a chronic autoimmune liver disease that if left untreated may lead to the development of cirrhosis. Previous studies on AIH patients have suggested that fibrosis and even cirrhosis can be reversed by medical treatment. The aim of this study was to evaluate the efficacy of medical treatment for protection of developing fibrosis and cirrhosis.

Methods Two hundred fifty-eight liver biopsies from 101 patients (72 women, 29 men) were analysed by a single pathologist and classified accordingly to the Ishak grading (inflammation) and staging (fibrosis) system. Liver histology was stratified according to the temporal changes of fibrosis stage (increased, decreased or stable), and groups were compared.

Results Complete or partial response to medical treatment was 94.9%. Reduction of fibrosis stage from the first to the last biopsy was seen in 63 patients (62.4%). We found an association between a reduction in fibrosis stage and continuous glucocorticoid medication, as well as lowered scores of inflammation at last biopsy. Twenty-one patients had cirrhosis (Ishak stage 6) at least in one of the previous biopsies, but only five patients at the last biopsy.

Conclusions Histological improvement is common in AIH patients that respond to medical treatment, and a reduction or stabilization of fibrosis stage occurs in about 2/3 of such patients.

Keywords
autoimmune hepatitis, autoimmune liver disease, cirrhosis, fibrosis, inflammation
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:umu:diva-134616 (URN)10.1097/MD.0000000000007708 (DOI)000408504800012 ()
Note

Originally included in thesis in manuscript form 

Available from: 2017-05-09 Created: 2017-05-09 Last updated: 2018-06-09Bibliographically approved
Alaish, R., Lundgren, D., Suhr, O. B., Werner, M. & Karling, P. (2017). Safety of azathioprine and 6-mercaptopurine in patients with inflammatory bowel disease naive to thiopurine treatment. International journal of clinical pharmacology and therapeutics, 55(7), 594-600
Open this publication in new window or tab >>Safety of azathioprine and 6-mercaptopurine in patients with inflammatory bowel disease naive to thiopurine treatment
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2017 (English)In: International journal of clinical pharmacology and therapeutics, ISSN 0946-1965, Vol. 55, no 7, p. 594-600Article in journal (Refereed) Published
Abstract [en]

Objectives: To determine if 6-mercaptopurine (MP) is better tolerated than azathioprine (AZA) as the initial thiopurine treatment in patients suffering from inflammatory bowel disease (IBD). Switching patients with IBD from AZA to MP is advocated in patients intolerant to AZA. However, no study has determined if MP is more suited than AZA as a first-line treatment for patients who are naive to thiopurine treatment. Study: The tolerance of AZA and MP treatments in clinical practice was retrospectively evaluated from start to 12 months after initiating treatment in 113 patients with IBD who were all naive to thiopurines (82 patients treated with AZA and 31 patients with MP). Results: 65% of the patients treated with AZA and 61% of the patients treated with MP tolerated their treatment during 12 months (i.e., no group difference, p = 0.742). No difference in reported side effects between the two treatments was observed. The mean equivalent initial dose (0.92 vs. 0.61 mg/kg; p < 0.001) and the mean equivalent dose at 12 months (1.98 vs. 1.65 mg/kg; p = 0.014) was significantly higher in the MP group vs. the AZA group. The proportion of patients with.MCV = 7 at 12 months was numerically higher in the MP group than in the AZA group (53% vs. 31%; p = 0.090). Conclusions: In this retrospective observational study, no differences in tolerance or adherence between AZA and MP were observed in patients naive to thiopurines. However, MP treatment was at a higher equivalent thiopurine dose than AZA treatment, which tended to be associated with better treatment response.

Place, publisher, year, edition, pages
DUSTRI-VERLAG DR KARL FEISTLE, 2017
Keywords
azathioprine, Crohn's disease, inflammatory bowel disease, mercaptopurine, ulcerative colitis
National Category
Gastroenterology and Hepatology Rheumatology and Autoimmunity Dermatology and Venereal Diseases
Identifiers
urn:nbn:se:umu:diva-137974 (URN)10.5414/CP202962 (DOI)000404885900007 ()28406092 (PubMedID)
Available from: 2017-08-02 Created: 2017-08-02 Last updated: 2018-06-09Bibliographically approved
Ibrahim, A., Dahlqvist, P., Olsson, T., Lundgren, D., Werner, M., Suhr, O. B. & Karling, P. (2017). The clinical course after glucocorticoid treatment in patients with inflammatory bowel disease is linked to suppression of the hypothalamic-pituitary-adrenal axis: a retrospective observational study. Therapeutic Advances in Gastroenterology, 10(11), 829-836
Open this publication in new window or tab >>The clinical course after glucocorticoid treatment in patients with inflammatory bowel disease is linked to suppression of the hypothalamic-pituitary-adrenal axis: a retrospective observational study
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2017 (English)In: Therapeutic Advances in Gastroenterology, ISSN 1756-283X, E-ISSN 1756-2848, Vol. 10, no 11, p. 829-836Article in journal (Refereed) Published
Abstract [en]

Background: Adrenal insufficiency (AI) secondary to treatment with glucocorticoids (GCs) is common in patients with inflammatory bowel disease (IBD), but little is known about the relationship between AI and the clinical course in IBD. The aim of the study was to compare the clinical course in IBD patients with normal adrenal function versus patients with subnormal adrenal function.

Methods: A retrospective observational study on 63 patients with IBD who had performed a low-dose short Synacthen test (LDSST) (1 μg) immediately (1-7 days) after a standard course of GCs. A subnormal LDSST was defined as serum cortisol <550 nmol/L. Outcomes were time to next flare and fecal calprotectin levels.

Results: Sixty-three percent (n = 40) of the IBD patients had a subnormal LDSST. Patients who were steroid-free (n = 41) after the LDSST were observed for 3 years. Patients with a peak serum cortisol <400 nmol/L immediately after GC treatment had significantly longer time until the next flare-up of their IBD and tended to use a lower cumulative prednisolone dose during the study period in comparison to the other subgroups. Fecal calprotectin levels were significantly lower in patients with a peak s-cortisol <550 nmol/L versus patients with peak s-cortisol ⩾550 nmol/L (median 336 µg/g (IQR 521) versus 955 µg/g (IQR 1867); p = 0.012).

Conclusions: GC-induced AI is common in patients with IBD and is associated with lower disease activity. This suggests a link between responsiveness to GC treatment and suppression of the hypothalamic-pituitary-adrenal axis in IBD.

Place, publisher, year, edition, pages
London: Sage Publications, 2017
Keywords
Crohn’s disease, adrenal insufficiency, clinical pharmacology, immunosuppression, inflammatory bowel disease, ulcerative colitis
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:umu:diva-142067 (URN)10.1177/1756283X17730748 (DOI)000414470200002 ()29147134 (PubMedID)
Available from: 2017-11-20 Created: 2017-11-20 Last updated: 2018-06-09Bibliographically approved
Stepien, M., Duarte-Salles, T., Fedirko, V., Floegel, A., Barupal, D. K., Rinaldi, S., . . . Jenab, M. (2016). Alteration of amino acid and biogenic amine metabolism in hepatobiliary cancers: findings from a prospective cohort study. International Journal of Cancer, 138(2), 348-360
Open this publication in new window or tab >>Alteration of amino acid and biogenic amine metabolism in hepatobiliary cancers: findings from a prospective cohort study
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2016 (English)In: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 138, no 2, p. 348-360Article in journal (Refereed) Published
Abstract [en]

Perturbations in levels of amino acids (AA) and their derivatives are observed in hepatocellular carcinoma (HCC). Yet, it is unclear whether these alterations precede or are a consequence of the disease, nor whether they pertain to anatomically related cancers of the intrahepatic bile duct (IHBC), and gallbladder and extrahepatic biliary tract (GBTC). Circulating standard AA, biogenic amines and hexoses were measured (Biocrates AbsoluteIDQ-p180Kit) in a case-control study nested within a large prospective cohort (147 HCC, 43 IHBC and 134 GBTC cases). Liver function and hepatitis status biomarkers were determined separately. Multivariable conditional logistic regression was used to calculate odds ratios and 95% confidence intervals (OR; 95%CI) for log-transformed standardised (mean = 0, SD = 1) serum metabolite levels and relevant ratios in relation to HCC, IHBC or GBTC risk. Fourteen metabolites were significantly associated with HCC risk, of which seven metabolites and four ratios were the strongest predictors in continuous models. Leucine, lysine, glutamine and the ratio of branched chain to aromatic AA (Fischer's ratio) were inversely, while phenylalanine, tyrosine and their ratio, glutamate, glutamate/glutamine ratio, kynurenine and its ratio to tryptophan were positively associated with HCC risk. Confounding by hepatitis status and liver enzyme levels was observed. For the other cancers no significant associations were observed. In conclusion, imbalances of specific AA and biogenic amines may be involved in HCC development.

Place, publisher, year, edition, pages
John Wiley & Sons, 2016
Keywords
hepatocellular carcinoma, biliary tract cancers, prospective cohort, targeted metabolomics, amino acids
National Category
Cancer and Oncology Gastroenterology and Hepatology
Identifiers
urn:nbn:se:umu:diva-107518 (URN)10.1002/ijc.29718 (DOI)000369161200010 ()26238458 (PubMedID)
Available from: 2015-08-24 Created: 2015-08-24 Last updated: 2018-06-07Bibliographically approved
Duarte-Salles, T., Misra, S., Stepien, M., Plymoth, A., Muller, D., Overvad, K., . . . Beretta, L. (2016). Circulating Osteopontin and Prediction of Hepatocellular Carcinoma Development in a Large European Population. Cancer Prevention Research, 9(9), 758-765
Open this publication in new window or tab >>Circulating Osteopontin and Prediction of Hepatocellular Carcinoma Development in a Large European Population
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2016 (English)In: Cancer Prevention Research, ISSN 1940-6207, E-ISSN 1940-6215, Vol. 9, no 9, p. 758-765Article in journal (Refereed) Published
Abstract [en]

We previously identified osteopontin (OPN) as a promising marker for the early detection of hepatocellular carcinoma (HCC). In this study, we investigated the association between prediagnostic circulating OPN levels and HCC incidence in a large population-based cohort. A nested case-control study was conducted within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. During a mean follow-up of 4.8 years, 100 HCC cases were identified. Each case was matched to two controls and OPN levels were measured in baseline plasma samples. Viral hepatitis, liver function, and a-fetoprotein (AFP) tests were also conducted. Conditional logistic regression models were used to calculate multivariable odds ratio (OR) and 95% confidence intervals (95% CI) for OPN levels in relation to HCC. Receiver operating characteristics curves were constructed to determine the discriminatory accuracy of OPN alone or in combination with other liver biomarkers in the prediction of HCC. OPN levels were positively associated with HCC risk (per 10% increment, ORmultivariable = 1.30; 95% CI, 1.14-1.48). The association was stronger among cases diagnosed within 2 years of follow-up. Adding liver function tests to OPN improved the discriminatory performance for subjects who developed HCC (AUC = 0.86). For cases diagnosed within 2 years, the combination of OPN and AFP was best able to predict HCC risk (AUC = 0.88). The best predictive model for HCC in this low-risk population is OPN in combination with liver function tests. Within 2 years of diagnosis, the combination of OPN and AFP best predicted HCC development, suggesting that measuring OPN and AFP could identify high-risk groups independently of a liver disease diagnosis.

National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-126502 (URN)10.1158/1940-6207.CAPR-15-0434 (DOI)000383090500006 ()27339170 (PubMedID)
Available from: 2016-10-27 Created: 2016-10-10 Last updated: 2018-06-09Bibliographically approved
Danielsson Borssén, Å., Wallerstedt, S., Nyhlin, N., Bergquist, A., Lindgren, S., Almer, S. & Werner, M. (2016). Pregnancy and childbirth in women with autoimmune hepatitis is safe, even in compensated cirrhosis. Scandinavian Journal of Gastroenterology, 51(4), 479-485
Open this publication in new window or tab >>Pregnancy and childbirth in women with autoimmune hepatitis is safe, even in compensated cirrhosis
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2016 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 51, no 4, p. 479-485Article in journal (Refereed) Published
Abstract [en]

Introduction: Autoimmune hepatitis (AIH) is a liver disease that primarily affects women. Many become ill during childbearing age, and medication can be lifelong. Few studies exist on pregnancy outcome in women with AIH. 

Objectives: The aim was to assess the outcome of women with AIH and their children during pregnancy and postpartum.

Materials and methods: Sixty-four women from a well-characterised cohort with AIH filled out a questionnaire with information about their disease, miscarriage/abortion, pregnancies and potential birth defects in 2012. In 2004, 106 women answered the same questionnaire and their results were analysed along with the new questionnaires. 

Results: One hundred and thirty-eight women have completed the questionnaire and 100 children have been born by 58 women. Fifty-seven women (41%) had cirrhosis. In 84% of the pregnancies, the AIH was stable or milder, 32% had an increase in activity postpartum. The proportion of preterm births (before week 38) was 22%, caesarean sections 17%, malformations 3%, and two children died. Twenty-three women with cirrhosis had children after diagnosis of cirrhosis but without more complications than for non-cirrhotic mothers. However, they did have a higher prevalence of caesarean sections. 

Conclusion: Pregnancy and childbirth in AIH appear to be safe for both child and mother, even in women with compensated liver cirrhosis.

Place, publisher, year, edition, pages
Taylor & Francis, 2016
Keywords
Abortion, autoimmune, hepatitis, liver cirrhosis, pregnancy, pregnancy outcome, spontaneous
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:umu:diva-116729 (URN)10.3109/00365521.2015.1115893 (DOI)000368696900013 ()
Available from: 2016-02-19 Created: 2016-02-11 Last updated: 2018-06-07Bibliographically approved
Stepien, M., Fedirko, V., Duarte-Salles, T., Ferrari, P., Freisling, H., Trepo, E., . . . Jenab, M. (2016). Prospective association of liver function biomarkers with development of hepatobiliary cancers. Cancer Epidemiology, 40, 179-187
Open this publication in new window or tab >>Prospective association of liver function biomarkers with development of hepatobiliary cancers
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2016 (English)In: Cancer Epidemiology, ISSN 1877-7821, E-ISSN 1877-783X, Vol. 40, p. 179-187Article in journal (Refereed) Published
Abstract [en]

Introduction: Serum liver biomarkers (gamma-glutamyl transferase, GGT; alanine aminotransferase, ALT; aspartate aminotransferase, AST; alkaline phosphatase, ALP; total bilirubin) are used as indicators of liver disease, but there is currently little data on their prospective association with risk of hepatobiliary cancers. Methods: A nested-case control study was conducted within the prospective EPIC cohort (>520,000 participants, 10 European countries). After a mean 7.5 mean years of follow-up, 121 hepatocellular carcinoma (HCC), 34 intrahepatic bile duct (IHBC) and 131 gallbladder and biliary tract (GBTC) cases were identified and matched to 2 controls each. Circulating biomarkers were measured in serum taken at recruitment into the cohort, prior to cancer diagnosis. Multivariable adjusted conditional logistic regression was used to calculate odds ratios and 95% confidence intervals (OR; 95% CI). Results: In multivariable models, 1SD increase of each log-transformed biomarker was positively associated with HCC risk (OR(GGT) = 4.23, 95% CI: 2.72-6.59; OR(ALP) = 3.43, 95% CI: 2.31-5.10; OR(AST) = 3.00, 95% CI: 2.04-4.42; OR(ALT) = 2.69, 95% CI: 1.89-3.84; OR(Bilirubin) = 2.25, 95% CI: 1.58-3.20). Each liver enzyme (OR(GGT) = 4.98; 95% CI: 1.75-14.17; OR(AST) = 3.10, 95% CI: 1.04-9.30; OR(ALT) = 2.86, 95% CI: 1.26-6.48, OR(ALP) = 2.31, 95% CI: 1.10-4.86) but not bilirubin (OR(Bilirubin) = 1.46,95% CI: 0.85-2.51) showed a significant association with IHBC. Only ALP was significantly associated with GBTC risk (OR (ALP) = 1.59, 95% CI: 1.20-2.09). Conclusion: This study shows positive associations between circulating liver biomarkers in sera collected prior to cancer diagnoses and the risks of developing HCC or IHBC, but not GBTC.

Place, publisher, year, edition, pages
Elsevier, 2016
Keywords
Hepatobiliary cancer, Liver function test, Biological markers, Prospective cohort, Nested case-control udy
National Category
Cancer and Oncology Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-118263 (URN)10.1016/j.canep.2016.01.002 (DOI)000370167000025 ()26773278 (PubMedID)
Available from: 2016-03-17 Created: 2016-03-14 Last updated: 2018-06-07Bibliographically approved
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