S. Rashid1, E. Kim1, M. Cardeiro1, L. Frankel1, B. Nagel1, A. Sims6, O. M. Rashid1,2,3,4,5,6 1Nova Southeastern University, Dr. Kiran C. Patel, College Of Allopathic Medicine, Davie, FLORIDA, USA 2Massachusetts General Hospital, Boston, MA, USA 3University Of Miami, Miami, FL, USA 4Holy Cross Health, Fort Lauderdale, FL, USA 5Broward Health, Fort Lauderdale, FL, USA 6Nova Southeastern University, Dr. Kiran C. Patel, College Of Osteopathic Medicine, Davie, FLORIDA, USA
Introduction: The purpose of this study was to evaluate the correlation between the incidence of gallbladder carcinoma and endometriosis. Endometriosis is a prevalent disease of reproductive aged women and was found to reduce the development of malignancy in this project. Endometriosis causes greater immune activation of macrophages, with the higher levels of estrogen possibly activating receptors on macrophages and creating a strong anti-inflammatory environment, deterring the growth of cancerous cells. Estrogen also has been found to have anti-tumor effects on the development of colorectal cancer, providing an theory behind why women with endometriosis, and higher total serum estrogen, have a lower incidence of gallbladder carcinoma. Furthermore, the dysfunctions in the luteal phase of the menstrual cycle present in endometriosis may be protective against gallbladder disease as gallbladder emptying is impaired during this point in the cycle, demonstrating another possible etiology behind the reduction in gallbladder malignancy in women with endometriosis.
Methods: Data was provided by a HIPAA compliant national database to assess patients with a diagnosis of endometriosis versus patients without a diagnosis of endometriosis using ICD-10 and ICD-9 codes. Access to the database for the purpose of academic research and standard statistical analysis methods were utilized.
Results: Between January 2010 and December 2019, the query was analyzed and resulted in 14,387 patients in both the endometriosis and control group. These two groups were then matched by age range, CCI score, and were then analyzed for the incidence of gallbladder carcinoma. The incidence of gallbladder carcinoma was 0.18% in the experimental group and 0.82% in the control group. The difference was statistically significant by a P value < 6.022×10^-13 with an odds ratio of 0.269, 95% confidence interval between 0.185 and 0.394.
Conclusion: This study shows a statistically significant correlation between endometriosis and the development of gallbladder carcinoma, demonstrating a decreased risk in patients with a diagnosis of endometriosis. The results of this project were novel and there is minimal research done on the plausible connection between gallbladder malignancy and endometriosis. Further research is recommended to assess the specific hormone and immune modulating effects of endometriosis that confers a lower incidence in the development of gallbladder carcinoma. Potentially, the anti-inflammatory nature and menstrual cycle changes of endometriosis could prove an attractive therapeutic usage against the development of gallbladder neoplasms.
