Association of Aflatoxin and Gallbladder Cancer

Jill Koshiol; Yu-Tang Gao; Michael Dean; Patricia Egner; Chirag Nepal; Kristine Jones; Bingsheng Wang; Asif Rashid; Wen Luo; Alison Van Dyke; Catterina Ferreccio; Michael Malasky; Ming-Chang Shen; Bin Zhu; Jesper B Andersen; Allan Hildesheim; Ann W Hsing; John Groopman

doi:10.1053/j.gastro.2017.04.005

Association of Aflatoxin and Gallbladder Cancer

Jill Koshiol, Yu-Tang Gao, Michael Dean, Patricia Egner, Chirag Nepal, Kristine Jones, Bingsheng Wang, Asif Rashid, Wen Luo, Alison Van Dyke, Catterina Ferreccio, Michael Malasky, Ming-Chang Shen, Bin Zhu, Jesper B Andersen, Allan Hildesheim, Ann W Hsing, John Groopman

26 Citations (Scopus)

Abstract

Background & Aims Aflatoxin, which causes hepatocellular carcinoma, may also cause gallbladder cancer. We investigated whether patients with gallbladder cancer have higher exposure to aflatoxin than patients with gallstones. Methods We measured aflatoxin B₁ (AFB₁)–lysine adducts in plasma samples from the Shanghai Biliary Tract Cancer case-control study, conducted from 1997 through 2001. We calculated age- and sex-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) and the population-attributable fraction for 209 patients with gallbladder cancer and gallstones vs 250 patients with gallstones without cancer (controls). In 54 patients with gallbladder cancer, tumor tissue was examined for the R249S mutation in TP53, associated with aflatoxin exposure, through targeted sequencing. Results The AFB₁–lysine adduct was detected in 67 (32%) of 209 patients with gallbladder cancer and 37 (15%) of the 250 controls (χ² P <.0001), almost threefold more patients with gallbladder cancer than controls (OR, 2.71; 95% CI, 1.70–4.33). Among participants with detectable levels of AFB₁–lysine, the median level of AFB₁–lysine was 5.4 pg/mg in those with gallbladder cancer, compared with 1.2 pg/mg in controls. For patients in the fourth quartile of AFB₁–lysine level vs the first quartile, the OR for gallbladder cancer was 7.61 (95% CI, 2.01–28.84). None of the 54 gallbladder tumors sequenced were found to have the R249S mutation in TP53. The population-attributable fraction for cancer related to aflatoxin was 20% (95% CI, 15%–25%). Conclusions In a case-control study of patients with gallbladder cancer and gallstones vs patients with gallstones without cancer, we associated exposure to aflatoxin (based on plasma level of AFB₁–lysine) with gallbladder cancer. Gallbladder cancer does not appear associate with the R249S mutation in TP53. If aflatoxin is a cause of gallbladder cancer, it may have accounted for up to 20% of the gallbladder cancers in Shanghai, China, during the study period, and could account for an even higher proportion in high-risk areas. If our findings are verified, reducing aflatoxin exposure might reduce the incidence of gallbladder cancer.

Original language	English
Journal	Gastroenterology
Volume	153
Issue number	2
Pages (from-to)	488-494. e1
ISSN	0016-5085
DOIs	https://doi.org/10.1053/j.gastro.2017.04.005
Publication status	Published - Aug 2017

Keywords

Journal Article

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1053/j.gastro.2017.04.005

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@article{048da8a415564494bdc7c48ac8e649b9,

title = "Association of Aflatoxin and Gallbladder Cancer",

abstract = "Background & Aims Aflatoxin, which causes hepatocellular carcinoma, may also cause gallbladder cancer. We investigated whether patients with gallbladder cancer have higher exposure to aflatoxin than patients with gallstones. Methods We measured aflatoxin B1 (AFB1)–lysine adducts in plasma samples from the Shanghai Biliary Tract Cancer case-control study, conducted from 1997 through 2001. We calculated age- and sex-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) and the population-attributable fraction for 209 patients with gallbladder cancer and gallstones vs 250 patients with gallstones without cancer (controls). In 54 patients with gallbladder cancer, tumor tissue was examined for the R249S mutation in TP53, associated with aflatoxin exposure, through targeted sequencing. Results The AFB1–lysine adduct was detected in 67 (32%) of 209 patients with gallbladder cancer and 37 (15%) of the 250 controls (χ2 P <.0001), almost threefold more patients with gallbladder cancer than controls (OR, 2.71; 95% CI, 1.70–4.33). Among participants with detectable levels of AFB1–lysine, the median level of AFB1–lysine was 5.4 pg/mg in those with gallbladder cancer, compared with 1.2 pg/mg in controls. For patients in the fourth quartile of AFB1–lysine level vs the first quartile, the OR for gallbladder cancer was 7.61 (95% CI, 2.01–28.84). None of the 54 gallbladder tumors sequenced were found to have the R249S mutation in TP53. The population-attributable fraction for cancer related to aflatoxin was 20% (95% CI, 15%–25%). Conclusions In a case-control study of patients with gallbladder cancer and gallstones vs patients with gallstones without cancer, we associated exposure to aflatoxin (based on plasma level of AFB1–lysine) with gallbladder cancer. Gallbladder cancer does not appear associate with the R249S mutation in TP53. If aflatoxin is a cause of gallbladder cancer, it may have accounted for up to 20% of the gallbladder cancers in Shanghai, China, during the study period, and could account for an even higher proportion in high-risk areas. If our findings are verified, reducing aflatoxin exposure might reduce the incidence of gallbladder cancer.",

keywords = "Journal Article",

author = "Jill Koshiol and Yu-Tang Gao and Michael Dean and Patricia Egner and Chirag Nepal and Kristine Jones and Bingsheng Wang and Asif Rashid and Wen Luo and {Van Dyke}, Alison and Catterina Ferreccio and Michael Malasky and Ming-Chang Shen and Bin Zhu and Andersen, {Jesper B} and Allan Hildesheim and Hsing, {Ann W} and John Groopman",

year = "2017",

month = aug,

doi = "10.1053/j.gastro.2017.04.005",

language = "English",

volume = "153",

pages = "488--494. e1",

journal = "Gastroenterology",

issn = "0016-5085",

publisher = "Elsevier",

number = "2",

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TY - JOUR

T1 - Association of Aflatoxin and Gallbladder Cancer

AU - Koshiol, Jill

AU - Gao, Yu-Tang

AU - Dean, Michael

AU - Egner, Patricia

AU - Nepal, Chirag

AU - Jones, Kristine

AU - Wang, Bingsheng

AU - Rashid, Asif

AU - Luo, Wen

AU - Van Dyke, Alison

AU - Ferreccio, Catterina

AU - Malasky, Michael

AU - Shen, Ming-Chang

AU - Zhu, Bin

AU - Andersen, Jesper B

AU - Hildesheim, Allan

AU - Hsing, Ann W

AU - Groopman, John

PY - 2017/8

Y1 - 2017/8

N2 - Background & Aims Aflatoxin, which causes hepatocellular carcinoma, may also cause gallbladder cancer. We investigated whether patients with gallbladder cancer have higher exposure to aflatoxin than patients with gallstones. Methods We measured aflatoxin B1 (AFB1)–lysine adducts in plasma samples from the Shanghai Biliary Tract Cancer case-control study, conducted from 1997 through 2001. We calculated age- and sex-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) and the population-attributable fraction for 209 patients with gallbladder cancer and gallstones vs 250 patients with gallstones without cancer (controls). In 54 patients with gallbladder cancer, tumor tissue was examined for the R249S mutation in TP53, associated with aflatoxin exposure, through targeted sequencing. Results The AFB1–lysine adduct was detected in 67 (32%) of 209 patients with gallbladder cancer and 37 (15%) of the 250 controls (χ2 P <.0001), almost threefold more patients with gallbladder cancer than controls (OR, 2.71; 95% CI, 1.70–4.33). Among participants with detectable levels of AFB1–lysine, the median level of AFB1–lysine was 5.4 pg/mg in those with gallbladder cancer, compared with 1.2 pg/mg in controls. For patients in the fourth quartile of AFB1–lysine level vs the first quartile, the OR for gallbladder cancer was 7.61 (95% CI, 2.01–28.84). None of the 54 gallbladder tumors sequenced were found to have the R249S mutation in TP53. The population-attributable fraction for cancer related to aflatoxin was 20% (95% CI, 15%–25%). Conclusions In a case-control study of patients with gallbladder cancer and gallstones vs patients with gallstones without cancer, we associated exposure to aflatoxin (based on plasma level of AFB1–lysine) with gallbladder cancer. Gallbladder cancer does not appear associate with the R249S mutation in TP53. If aflatoxin is a cause of gallbladder cancer, it may have accounted for up to 20% of the gallbladder cancers in Shanghai, China, during the study period, and could account for an even higher proportion in high-risk areas. If our findings are verified, reducing aflatoxin exposure might reduce the incidence of gallbladder cancer.

AB - Background & Aims Aflatoxin, which causes hepatocellular carcinoma, may also cause gallbladder cancer. We investigated whether patients with gallbladder cancer have higher exposure to aflatoxin than patients with gallstones. Methods We measured aflatoxin B1 (AFB1)–lysine adducts in plasma samples from the Shanghai Biliary Tract Cancer case-control study, conducted from 1997 through 2001. We calculated age- and sex-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) and the population-attributable fraction for 209 patients with gallbladder cancer and gallstones vs 250 patients with gallstones without cancer (controls). In 54 patients with gallbladder cancer, tumor tissue was examined for the R249S mutation in TP53, associated with aflatoxin exposure, through targeted sequencing. Results The AFB1–lysine adduct was detected in 67 (32%) of 209 patients with gallbladder cancer and 37 (15%) of the 250 controls (χ2 P <.0001), almost threefold more patients with gallbladder cancer than controls (OR, 2.71; 95% CI, 1.70–4.33). Among participants with detectable levels of AFB1–lysine, the median level of AFB1–lysine was 5.4 pg/mg in those with gallbladder cancer, compared with 1.2 pg/mg in controls. For patients in the fourth quartile of AFB1–lysine level vs the first quartile, the OR for gallbladder cancer was 7.61 (95% CI, 2.01–28.84). None of the 54 gallbladder tumors sequenced were found to have the R249S mutation in TP53. The population-attributable fraction for cancer related to aflatoxin was 20% (95% CI, 15%–25%). Conclusions In a case-control study of patients with gallbladder cancer and gallstones vs patients with gallstones without cancer, we associated exposure to aflatoxin (based on plasma level of AFB1–lysine) with gallbladder cancer. Gallbladder cancer does not appear associate with the R249S mutation in TP53. If aflatoxin is a cause of gallbladder cancer, it may have accounted for up to 20% of the gallbladder cancers in Shanghai, China, during the study period, and could account for an even higher proportion in high-risk areas. If our findings are verified, reducing aflatoxin exposure might reduce the incidence of gallbladder cancer.

KW - Journal Article

U2 - 10.1053/j.gastro.2017.04.005

DO - 10.1053/j.gastro.2017.04.005

M3 - Journal article

C2 - 28428144

SN - 0016-5085

VL - 153

SP - 488-494. e1

JO - Gastroenterology

JF - Gastroenterology

IS - 2

ER -

Association of Aflatoxin and Gallbladder Cancer

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