Body Mass Index, Diabetes and Intrahepatic Cholangiocarcinoma Risk: The Liver Cancer Pooling Project and Meta-analysis

Obesity and diabetes are associated with an increased liver cancer risk. However, most studies have examined all primary liver cancers or hepatocellular carcinoma, with few studies evaluating intrahepatic cholangiocarcinoma (ICC), the second most common type of liver cancer. Thus, we examined the as...

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Published in:The American journal of gastroenterology Vol. 113; no. 10; pp. 1494 - 1505
Main Authors: Petrick, Jessica L, Thistle, Jake E, Zeleniuch-Jacquotte, Anne, Zhang, Xuehong, Wactawski-Wende, Jean, Van Dyke, Alison L, Stampfer, Meir J, Sinha, Rashmi, Sesso, Howard D, Schairer, Catherine, Rosenberg, Lynn, Rohan, Thomas E, Robien, Kim, Purdue, Mark P, Poynter, Jenny N, Palmer, Julie R, Newton, Christina C, Linet, Martha S, Liao, Linda M, Lee, I-Min, Koshiol, Jill, Kitahara, Cari M, Hofmann, Jonathan N, Graubard, Barry I, Giovannucci, Edward, Gaziano, Michael J, Gapstur, Susan M, Freedman, Neal D, Chong, Dawn Q, Chan, Andrew T, Buring, Julie E, Freeman, Laura Beane E, Campbell, Peter T, McGlynn, Katherine A
Format: Journal Article
Language:English
Published: United States Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins 01.10.2018
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ISSN:0002-9270, 1572-0241, 1572-0241
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Abstract Obesity and diabetes are associated with an increased liver cancer risk. However, most studies have examined all primary liver cancers or hepatocellular carcinoma, with few studies evaluating intrahepatic cholangiocarcinoma (ICC), the second most common type of liver cancer. Thus, we examined the association between obesity and diabetes and ICC risk in a pooled analysis and conducted a systematic review/meta-analysis of the literature. For the pooled analysis, we utilized the Liver Cancer Pooling Project, a consortium of 13 US-based, prospective cohort studies with data from 1,541,143 individuals (ICC cases n = 414). In our systematic review, we identified 14 additional studies. We then conducted a meta-analysis, combining the results from LCPP with results from the 5 prospective studies identified through September 2017. In the LCPP, obesity and diabetes were associated with a 62% [Hazard Ratio (HR) = 1.62, 95% Confidence Interval (CI): 1.24-2.12] and an 81% (HR = 1.81, 95% CI: 1.33-2.46) increased ICC risk, respectively. In the meta-analysis of prospectively ascertained cohorts and nested case-control studies, obesity was associated with a 49% increased ICC risk [Relative Risk (RR) = 1.49, 95% CI: 1.32-1.70; n = 4 studies; I  = 0%]. Diabetes was associated with a 53% increased ICC risk (RR = 1.53, 95% CI: 1.31-1.78; n = 6 studies). While we noted heterogeneity between studies (I  = 67%) for diabetes, results were consistent in subgroup analyses. Results from hospital-based case-control studies (n = 9) were mostly consistent, but these studies are potentially subject to reverse causation. These findings suggest that obesity and diabetes are associated with increased ICC risk, highlighting similar etiologies of hepatocellular carcinoma and intrahepatic cholangiocarcinoma. However, additional prospective studies are needed to verify these associations.
AbstractList ObjectiveObesity and diabetes are associated with an increased liver cancer risk. However, most studies have examined all primary liver cancers or hepatocellular carcinoma, with few studies evaluating intrahepatic cholangiocarcinoma (ICC), the second most common type of liver cancer. Thus, we examined the association between obesity and diabetes and ICC risk in a pooled analysis and conducted a systematic review/meta-analysis of the literature.DesignFor the pooled analysis, we utilized the Liver Cancer Pooling Project, a consortium of 13 US-based, prospective cohort studies with data from 1,541,143 individuals (ICC cases n = 414). In our systematic review, we identified 14 additional studies. We then conducted a meta-analysis, combining the results from LCPP with results from the 5 prospective studies identified through September 2017.ResultsIn the LCPP, obesity and diabetes were associated with a 62% [Hazard Ratio (HR) = 1.62, 95% Confidence Interval (CI): 1.24–2.12] and an 81% (HR = 1.81, 95% CI: 1.33–2.46) increased ICC risk, respectively. In the meta-analysis of prospectively ascertained cohorts and nested case-control studies, obesity was associated with a 49% increased ICC risk [Relative Risk (RR) = 1.49, 95% CI: 1.32–1.70; n = 4 studies; I2 = 0%]. Diabetes was associated with a 53% increased ICC risk (RR = 1.53, 95% CI: 1.31–1.78; n = 6 studies). While we noted heterogeneity between studies (I2 = 67%) for diabetes, results were consistent in subgroup analyses. Results from hospital-based case–control studies (n = 9) were mostly consistent, but these studies are potentially subject to reverse causation.ConclusionsThese findings suggest that obesity and diabetes are associated with increased ICC risk, highlighting similar etiologies of hepatocellular carcinoma and intrahepatic cholangiocarcinoma. However, additional prospective studies are needed to verify these associations.
Obesity and diabetes are associated with an increased liver cancer risk. However, most studies have examined all primary liver cancers or hepatocellular carcinoma, with few studies evaluating intrahepatic cholangiocarcinoma (ICC), the second most common type of liver cancer. Thus, we examined the association between obesity and diabetes and ICC risk in a pooled analysis and conducted a systematic review/meta-analysis of the literature.OBJECTIVEObesity and diabetes are associated with an increased liver cancer risk. However, most studies have examined all primary liver cancers or hepatocellular carcinoma, with few studies evaluating intrahepatic cholangiocarcinoma (ICC), the second most common type of liver cancer. Thus, we examined the association between obesity and diabetes and ICC risk in a pooled analysis and conducted a systematic review/meta-analysis of the literature.For the pooled analysis, we utilized the Liver Cancer Pooling Project, a consortium of 13 US-based, prospective cohort studies with data from 1,541,143 individuals (ICC cases n = 414). In our systematic review, we identified 14 additional studies. We then conducted a meta-analysis, combining the results from LCPP with results from the 5 prospective studies identified through September 2017.DESIGNFor the pooled analysis, we utilized the Liver Cancer Pooling Project, a consortium of 13 US-based, prospective cohort studies with data from 1,541,143 individuals (ICC cases n = 414). In our systematic review, we identified 14 additional studies. We then conducted a meta-analysis, combining the results from LCPP with results from the 5 prospective studies identified through September 2017.In the LCPP, obesity and diabetes were associated with a 62% [Hazard Ratio (HR) = 1.62, 95% Confidence Interval (CI): 1.24-2.12] and an 81% (HR = 1.81, 95% CI: 1.33-2.46) increased ICC risk, respectively. In the meta-analysis of prospectively ascertained cohorts and nested case-control studies, obesity was associated with a 49% increased ICC risk [Relative Risk (RR) = 1.49, 95% CI: 1.32-1.70; n = 4 studies; I2 = 0%]. Diabetes was associated with a 53% increased ICC risk (RR = 1.53, 95% CI: 1.31-1.78; n = 6 studies). While we noted heterogeneity between studies (I2 = 67%) for diabetes, results were consistent in subgroup analyses. Results from hospital-based case-control studies (n = 9) were mostly consistent, but these studies are potentially subject to reverse causation.RESULTSIn the LCPP, obesity and diabetes were associated with a 62% [Hazard Ratio (HR) = 1.62, 95% Confidence Interval (CI): 1.24-2.12] and an 81% (HR = 1.81, 95% CI: 1.33-2.46) increased ICC risk, respectively. In the meta-analysis of prospectively ascertained cohorts and nested case-control studies, obesity was associated with a 49% increased ICC risk [Relative Risk (RR) = 1.49, 95% CI: 1.32-1.70; n = 4 studies; I2 = 0%]. Diabetes was associated with a 53% increased ICC risk (RR = 1.53, 95% CI: 1.31-1.78; n = 6 studies). While we noted heterogeneity between studies (I2 = 67%) for diabetes, results were consistent in subgroup analyses. Results from hospital-based case-control studies (n = 9) were mostly consistent, but these studies are potentially subject to reverse causation.These findings suggest that obesity and diabetes are associated with increased ICC risk, highlighting similar etiologies of hepatocellular carcinoma and intrahepatic cholangiocarcinoma. However, additional prospective studies are needed to verify these associations.CONCLUSIONSThese findings suggest that obesity and diabetes are associated with increased ICC risk, highlighting similar etiologies of hepatocellular carcinoma and intrahepatic cholangiocarcinoma. However, additional prospective studies are needed to verify these associations.
Obesity and diabetes are associated with an increased liver cancer risk. However, most studies have examined all primary liver cancers or hepatocellular carcinoma, with few studies evaluating intrahepatic cholangiocarcinoma (ICC), the second most common type of liver cancer. Thus, we examined the association between obesity and diabetes and ICC risk in a pooled analysis and conducted a systematic review/meta-analysis of the literature. For the pooled analysis, we utilized the Liver Cancer Pooling Project, a consortium of 13 US-based, prospective cohort studies with data from 1,541,143 individuals (ICC cases n = 414). In our systematic review, we identified 14 additional studies. We then conducted a meta-analysis, combining the results from LCPP with results from the 5 prospective studies identified through September 2017. In the LCPP, obesity and diabetes were associated with a 62% [Hazard Ratio (HR) = 1.62, 95% Confidence Interval (CI): 1.24-2.12] and an 81% (HR = 1.81, 95% CI: 1.33-2.46) increased ICC risk, respectively. In the meta-analysis of prospectively ascertained cohorts and nested case-control studies, obesity was associated with a 49% increased ICC risk [Relative Risk (RR) = 1.49, 95% CI: 1.32-1.70; n = 4 studies; I  = 0%]. Diabetes was associated with a 53% increased ICC risk (RR = 1.53, 95% CI: 1.31-1.78; n = 6 studies). While we noted heterogeneity between studies (I  = 67%) for diabetes, results were consistent in subgroup analyses. Results from hospital-based case-control studies (n = 9) were mostly consistent, but these studies are potentially subject to reverse causation. These findings suggest that obesity and diabetes are associated with increased ICC risk, highlighting similar etiologies of hepatocellular carcinoma and intrahepatic cholangiocarcinoma. However, additional prospective studies are needed to verify these associations.
Author Freedman, Neal D
Hofmann, Jonathan N
Wactawski-Wende, Jean
Schairer, Catherine
Petrick, Jessica L
Gapstur, Susan M
Rosenberg, Lynn
Liao, Linda M
Newton, Christina C
Chong, Dawn Q
Kitahara, Cari M
Chan, Andrew T
Freeman, Laura Beane E
Zeleniuch-Jacquotte, Anne
Buring, Julie E
Zhang, Xuehong
McGlynn, Katherine A
Robien, Kim
Gaziano, Michael J
Campbell, Peter T
Rohan, Thomas E
Lee, I-Min
Purdue, Mark P
Graubard, Barry I
Linet, Martha S
Koshiol, Jill
Palmer, Julie R
Sesso, Howard D
Thistle, Jake E
Sinha, Rashmi
Poynter, Jenny N
Giovannucci, Edward
Stampfer, Meir J
Van Dyke, Alison L
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  fullname: Petrick, Jessica L
  organization: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA. Department of Population Health, New York University School of Medicine, New York, NY, USA. Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA. Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY, USA. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA. Slone Epidemiology Center at Boston University, Boston, MA, USA. Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA. Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC, USA. Division of Pediatric Epidemiology and Clinical Research and Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA. Epidemiology Research Program, American Cancer Society, Atlanta, GA, USA. VA Boston Healthcare System, Boston, MA, USA. Division of Medical Oncology, National Cancer Centre, Singapore, Singapore. Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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  organization: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA. Department of Population Health, New York University School of Medicine, New York, NY, USA. Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA. Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY, USA. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA. Slone Epidemiology Center at Boston University, Boston, MA, USA. Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA. Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC, USA. Division of Pediatric Epidemiology and Clinical Research and Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA. Epidemiology Research Program, American Cancer Society, Atlanta, GA, USA. VA Boston Healthcare System, Boston, MA, USA. Division of Medical Oncology, National Cancer Centre, Singapore, Singapore. Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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  givenname: Meir J
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  organization: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA. Department of Population Health, New York University School of Medicine, New York, NY, USA. Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA. Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY, USA. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA. Slone Epidemiology Center at Boston University, Boston, MA, USA. Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA. Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC, USA. Division of Pediatric Epidemiology and Clinical Research and Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA. Epidemiology Research Program, American Cancer Society, Atlanta, GA, USA. VA Boston Healthcare System, Boston, MA, USA. Division of Medical Oncology, National Cancer Centre, Singapore, Singapore. Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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  givenname: Thomas E
  surname: Rohan
  fullname: Rohan, Thomas E
  organization: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA. Department of Population Health, New York University School of Medicine, New York, NY, USA. Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA. Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY, USA. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA. Slone Epidemiology Center at Boston University, Boston, MA, USA. Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA. Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC, USA. Division of Pediatric Epidemiology and Clinical Research and Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA. Epidemiology Research Program, American Cancer Society, Atlanta, GA, USA. VA Boston Healthcare System, Boston, MA, USA. Division of Medical Oncology, National Cancer Centre, Singapore, Singapore. Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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  givenname: Kim
  surname: Robien
  fullname: Robien, Kim
  organization: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA. Department of Population Health, New York University School of Medicine, New York, NY, USA. Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA. Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY, USA. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA. Slone Epidemiology Center at Boston University, Boston, MA, USA. Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA. Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC, USA. Division of Pediatric Epidemiology and Clinical Research and Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA. Epidemiology Research Program, American Cancer Society, Atlanta, GA, USA. VA Boston Healthcare System, Boston, MA, USA. Division of Medical Oncology, National Cancer Centre, Singapore, Singapore. Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
– sequence: 14
  givenname: Mark P
  surname: Purdue
  fullname: Purdue, Mark P
  organization: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA. Department of Population Health, New York University School of Medicine, New York, NY, USA. Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA. Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY, USA. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA. Slone Epidemiology Center at Boston University, Boston, MA, USA. Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA. Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC, USA. Division of Pediatric Epidemiology and Clinical Research and Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA. Epidemiology Research Program, American Cancer Society, Atlanta, GA, USA. VA Boston Healthcare System, Boston, MA, USA. Division of Medical Oncology, National Cancer Centre, Singapore, Singapore. Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
– sequence: 15
  givenname: Jenny N
  surname: Poynter
  fullname: Poynter, Jenny N
  organization: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA. Department of Population Health, New York University School of Medicine, New York, NY, USA. Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA. Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY, USA. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA. Slone Epidemiology Center at Boston University, Boston, MA, USA. Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA. Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC, USA. Division of Pediatric Epidemiology and Clinical Research and Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA. Epidemiology Research Program, American Cancer Society, Atlanta, GA, USA. VA Boston Healthcare System, Boston, MA, USA. Division of Medical Oncology, National Cancer Centre, Singapore, Singapore. Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
– sequence: 16
  givenname: Julie R
  surname: Palmer
  fullname: Palmer, Julie R
  organization: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA. Department of Population Health, New York University School of Medicine, New York, NY, USA. Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA. Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY, USA. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA. Slone Epidemiology Center at Boston University, Boston, MA, USA. Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA. Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC, USA. Division of Pediatric Epidemiology and Clinical Research and Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA. Epidemiology Research Program, American Cancer Society, Atlanta, GA, USA. VA Boston Healthcare System, Boston, MA, USA. Division of Medical Oncology, National Cancer Centre, Singapore, Singapore. Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
– sequence: 17
  givenname: Christina C
  surname: Newton
  fullname: Newton, Christina C
  organization: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA. Department of Population Health, New York University School of Medicine, New York, NY, USA. Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA. Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY, USA. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA. Slone Epidemiology Center at Boston University, Boston, MA, USA. Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA. Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC, USA. Division of Pediatric Epidemiology and Clinical Research and Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA. Epidemiology Research Program, American Cancer Society, Atlanta, GA, USA. VA Boston Healthcare System, Boston, MA, USA. Division of Medical Oncology, National Cancer Centre, Singapore, Singapore. Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
– sequence: 18
  givenname: Martha S
  surname: Linet
  fullname: Linet, Martha S
  organization: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA. Department of Population Health, New York University School of Medicine, New York, NY, USA. Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA. Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY, USA. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA. Slone Epidemiology Center at Boston University, Boston, MA, USA. Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA. Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC, USA. Division of Pediatric Epidemiology and Clinical Research and Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA. Epidemiology Research Program, American Cancer Society, Atlanta, GA, USA. VA Boston Healthcare System, Boston, MA, USA. Division of Medical Oncology, National Cancer Centre, Singapore, Singapore. Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
– sequence: 19
  givenname: Linda M
  surname: Liao
  fullname: Liao, Linda M
  organization: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA. Department of Population Health, New York University School of Medicine, New York, NY, USA. Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA. Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY, USA. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA. Slone Epidemiology Center at Boston University, Boston, MA, USA. Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA. Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC, USA. Division of Pediatric Epidemiology and Clinical Research and Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA. Epidemiology Research Program, American Cancer Society, Atlanta, GA, USA. VA Boston Healthcare System, Boston, MA, USA. Division of Medical Oncology, National Cancer Centre, Singapore, Singapore. Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
– sequence: 20
  givenname: I-Min
  surname: Lee
  fullname: Lee, I-Min
  organization: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA. Department of Population Health, New York University School of Medicine, New York, NY, USA. Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA. Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY, USA. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA. Slone Epidemiology Center at Boston University, Boston, MA, USA. Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA. Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC, USA. Division of Pediatric Epidemiology and Clinical Research and Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA. Epidemiology Research Program, American Cancer Society, Atlanta, GA, USA. VA Boston Healthcare System, Boston, MA, USA. Division of Medical Oncology, National Cancer Centre, Singapore, Singapore. Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
– sequence: 21
  givenname: Jill
  surname: Koshiol
  fullname: Koshiol, Jill
  organization: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA. Department of Population Health, New York University School of Medicine, New York, NY, USA. Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA. Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY, USA. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA. Slone Epidemiology Center at Boston University, Boston, MA, USA. Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA. Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC, USA. Division of Pediatric Epidemiology and Clinical Research and Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA. Epidemiology Research Program, American Cancer Society, Atlanta, GA, USA. VA Boston Healthcare System, Boston, MA, USA. Division of Medical Oncology, National Cancer Centre, Singapore, Singapore. Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
– sequence: 22
  givenname: Cari M
  surname: Kitahara
  fullname: Kitahara, Cari M
  organization: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA. Department of Population Health, New York University School of Medicine, New York, NY, USA. Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA. Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY, USA. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA. Slone Epidemiology Center at Boston University, Boston, MA, USA. Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA. Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC, USA. Division of Pediatric Epidemiology and Clinical Research and Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA. Epidemiology Research Program, American Cancer Society, Atlanta, GA, USA. VA Boston Healthcare System, Boston, MA, USA. Division of Medical Oncology, National Cancer Centre, Singapore, Singapore. Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
– sequence: 23
  givenname: Jonathan N
  surname: Hofmann
  fullname: Hofmann, Jonathan N
  organization: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA. Department of Population Health, New York University School of Medicine, New York, NY, USA. Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA. Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY, USA. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA. Slone Epidemiology Center at Boston University, Boston, MA, USA. Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA. Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC, USA. Division of Pediatric Epidemiology and Clinical Research and Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA. Epidemiology Research Program, American Cancer Society, Atlanta, GA, USA. VA Boston Healthcare System, Boston, MA, USA. Division of Medical Oncology, National Cancer Centre, Singapore, Singapore. Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
– sequence: 24
  givenname: Barry I
  surname: Graubard
  fullname: Graubard, Barry I
  organization: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA. Department of Population Health, New York University School of Medicine, New York, NY, USA. Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA. Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY, USA. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA. Slone Epidemiology Center at Boston University, Boston, MA, USA. Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA. Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC, USA. Division of Pediatric Epidemiology and Clinical Research and Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA. Epidemiology Research Program, American Cancer Society, Atlanta, GA, USA. VA Boston Healthcare System, Boston, MA, USA. Division of Medical Oncology, National Cancer Centre, Singapore, Singapore. Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
– sequence: 25
  givenname: Edward
  surname: Giovannucci
  fullname: Giovannucci, Edward
  organization: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA. Department of Population Health, New York University School of Medicine, New York, NY, USA. Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA. Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY, USA. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA. Slone Epidemiology Center at Boston University, Boston, MA, USA. Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA. Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC, USA. Division of Pediatric Epidemiology and Clinical Research and Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA. Epidemiology Research Program, American Cancer Society, Atlanta, GA, USA. VA Boston Healthcare System, Boston, MA, USA. Division of Medical Oncology, National Cancer Centre, Singapore, Singapore. Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
– sequence: 26
  givenname: Michael J
  surname: Gaziano
  fullname: Gaziano, Michael J
  organization: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA. Department of Population Health, New York University School of Medicine, New York, NY, USA. Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA. Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY, USA. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA. Slone Epidemiology Center at Boston University, Boston, MA, USA. Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA. Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC, USA. Division of Pediatric Epidemiology and Clinical Research and Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA. Epidemiology Research Program, American Cancer Society, Atlanta, GA, USA. VA Boston Healthcare System, Boston, MA, USA. Division of Medical Oncology, National Cancer Centre, Singapore, Singapore. Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
– sequence: 27
  givenname: Susan M
  surname: Gapstur
  fullname: Gapstur, Susan M
  organization: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA. Department of Population Health, New York University School of Medicine, New York, NY, USA. Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA. Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY, USA. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA. Slone Epidemiology Center at Boston University, Boston, MA, USA. Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA. Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC, USA. Division of Pediatric Epidemiology and Clinical Research and Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA. Epidemiology Research Program, American Cancer Society, Atlanta, GA, USA. VA Boston Healthcare System, Boston, MA, USA. Division of Medical Oncology, National Cancer Centre, Singapore, Singapore. Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
– sequence: 28
  givenname: Neal D
  surname: Freedman
  fullname: Freedman, Neal D
  organization: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA. Department of Population Health, New York University School of Medicine, New York, NY, USA. Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA. Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY, USA. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA. Slone Epidemiology Center at Boston University, Boston, MA, USA. Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA. Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC, USA. Division of Pediatric Epidemiology and Clinical Research and Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA. Epidemiology Research Program, American Cancer Society, Atlanta, GA, USA. VA Boston Healthcare System, Boston, MA, USA. Division of Medical Oncology, National Cancer Centre, Singapore, Singapore. Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
– sequence: 29
  givenname: Dawn Q
  surname: Chong
  fullname: Chong, Dawn Q
  organization: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA. Department of Population Health, New York University School of Medicine, New York, NY, USA. Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA. Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY, USA. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA. Slone Epidemiology Center at Boston University, Boston, MA, USA. Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA. Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC, USA. Division of Pediatric Epidemiology and Clinical Research and Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA. Epidemiology Research Program, American Cancer Society, Atlanta, GA, USA. VA Boston Healthcare System, Boston, MA, USA. Division of Medical Oncology, National Cancer Centre, Singapore, Singapore. Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
– sequence: 30
  givenname: Andrew T
  surname: Chan
  fullname: Chan, Andrew T
  organization: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA. Department of Population Health, New York University School of Medicine, New York, NY, USA. Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA. Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY, USA. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA. Slone Epidemiology Center at Boston University, Boston, MA, USA. Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA. Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC, USA. Division of Pediatric Epidemiology and Clinical Research and Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA. Epidemiology Research Program, American Cancer Society, Atlanta, GA, USA. VA Boston Healthcare System, Boston, MA, USA. Division of Medical Oncology, National Cancer Centre, Singapore, Singapore. Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
– sequence: 31
  givenname: Julie E
  surname: Buring
  fullname: Buring, Julie E
  organization: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA. Department of Population Health, New York University School of Medicine, New York, NY, USA. Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA. Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY, USA. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA. Slone Epidemiology Center at Boston University, Boston, MA, USA. Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA. Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC, USA. Division of Pediatric Epidemiology and Clinical Research and Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA. Epidemiology Research Program, American Cancer Society, Atlanta, GA, USA. VA Boston Healthcare System, Boston, MA, USA. Division of Medical Oncology, National Cancer Centre, Singapore, Singapore. Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
– sequence: 32
  givenname: Laura Beane E
  surname: Freeman
  fullname: Freeman, Laura Beane E
  organization: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA. Department of Population Health, New York University School of Medicine, New York, NY, USA. Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA. Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY, USA. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA. Slone Epidemiology Center at Boston University, Boston, MA, USA. Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA. Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC, USA. Division of Pediatric Epidemiology and Clinical Research and Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA. Epidemiology Research Program, American Cancer Society, Atlanta, GA, USA. VA Boston Healthcare System, Boston, MA, USA. Division of Medical Oncology, National Cancer Centre, Singapore, Singapore. Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
– sequence: 33
  givenname: Peter T
  surname: Campbell
  fullname: Campbell, Peter T
  organization: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA. Department of Population Health, New York University School of Medicine, New York, NY, USA. Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA. Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY, USA. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA. Slone Epidemiology Center at Boston University, Boston, MA, USA. Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA. Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC, USA. Division of Pediatric Epidemiology and Clinical Research and Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA. Epidemiology Research Program, American Cancer Society, Atlanta, GA, USA. VA Boston Healthcare System, Boston, MA, USA. Division of Medical Oncology, National Cancer Centre, Singapore, Singapore. Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
– sequence: 34
  givenname: Katherine A
  surname: McGlynn
  fullname: McGlynn, Katherine A
  organization: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA. Department of Population Health, New York University School of Medicine, New York, NY, USA. Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA. Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY, USA. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA. Slone Epidemiology Center at Boston University, Boston, MA, USA. Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA. Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC, USA. Division of Pediatric Epidemiology and Clinical Research and Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA. Epidemiology Research Program, American Cancer Society, Atlanta, GA, USA. VA Boston Healthcare System, Boston, MA, USA. Division of Medical Oncology, National Cancer Centre, Singapore, Singapore. Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
BackLink https://www.ncbi.nlm.nih.gov/pubmed/30177781$$D View this record in MEDLINE/PubMed
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ContentType Journal Article
Copyright Copyright Nature Publishing Group Oct 2018
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PublicationTitle The American journal of gastroenterology
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Snippet Obesity and diabetes are associated with an increased liver cancer risk. However, most studies have examined all primary liver cancers or hepatocellular...
ObjectiveObesity and diabetes are associated with an increased liver cancer risk. However, most studies have examined all primary liver cancers or...
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SubjectTerms Bile Duct Neoplasms - epidemiology
Body Mass Index
Cholangiocarcinoma - epidemiology
Diabetes
Diabetes Mellitus, Type 2 - epidemiology
Gastroenterology
Humans
Incidence
Liver cancer
Liver Neoplasms - epidemiology
Meta-analysis
Obesity
Obesity - diagnosis
Obesity - epidemiology
Proportional Hazards Models
Risk Assessment
Risk Factors
Systematic review
Title Body Mass Index, Diabetes and Intrahepatic Cholangiocarcinoma Risk: The Liver Cancer Pooling Project and Meta-analysis
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