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% 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 of 209 patients with gallbladder cancer (32%) and 37 of the 250 controls (15%) (χ2 P <.0001), almost 3-fold 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 to 1.2 pg/mg in controls. For patients in the 4th of quartile of AFB1–lysine level vs the 1st 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%…
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