Comorbidities such as bile duct infection, viral hepatitis, chronic obstructive pulmonary disease (COPD), and alcohol-related liver disease could increase the risk of several hepatobiliary cancers, including cholangiocarcinoma (CCA) and hepatocellular carcinoma, according to an article recently published in the International Journal of Cancer.

Although there are many known environmental risk factors for hepatobiliary cancers, there is scarce literature on the role of comorbidities such as diabetes and COPD in the pathogenesis of hepatobiliary cancer. Furthermore, it is unclear whether these comorbidities are associated with specific cancer types.

The authors aimed to use standardized incidence ratios (SIRs) of previously diagnosed comorbidities for hepatobiliary cancers, including CCA, hepatocellular carcinoma, and gallbladder cancer. They used data from the inpatient Swedish register starting in 1987 and were able to perform follow-ups until 2018.

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Some of the selected 13 comorbidities included diabetes, COPD, viral hepatitis, gallstone disease, autoimmune hepatitis, and obesity. The authors performed a follow-up of each patient with the selected comorbidity until death, cancer diagnosis, emigration, or end of the follow-up period. The authors calculated SIRs as the ratio between observed cases and the expected number of cases.

The total population included over 13 million persons with a mean age of 69 years. The incidence rates for hepatobiliary cancer were 5 in every 100,000 men and 3.5 in every 100,000 women. In the case of CCA, all comorbidities but autoimmune hepatitis were associated with a higher risk.

“In conclusion, patients diagnosed with the selected 13 comorbidities from the National Inpatient Register had high risks of subsequent specific hepatobiliary cancer,” the authors wrote.


Hemminki K, Sundquist K, Sundquist J, et al. Personal comorbidities and their subsequent risks for liver, gallbladder and bile duct cancers. Int J Cancer. Published online October 4, 2022. doi:10.1002/ijc.34308