Impact of age at appendectomy on development of HCC: A population-based cohort study

Volume 9, Issue 1, February 2024     |     PP. 32-44      |     PDF (161 K)    |     Pub. Date: January 24, 2021
DOI: 10.54647/cm32404    192 Downloads     1304 Views  


Yang-Ming Lee, Department of Medicine, Kaohsiung Medical University No. 100, Shih-Chuan 1st Road, Kaohsiung 807, Taiwan; Internal Medicine Research Center, Changhua Christian Hospital, Changhua, Taiwan
Chew-Teng Kor, Internal Medicine Research Center, Changhua Christian Hospital, Changhua, Taiwan

Aim: The etiology and epidemiology of hepatocellular carcinoma (HCC) has been linked to the entero-ecosystem, involving microbiome and entero-hepatic endocrine system. The human appendix, a microbial reservoir for repopulating the gastrointestinal tract, has currently been considered a crucial part of the immune system. Thus, appendectomy may change gut microbial structure and immune function, thereby increasing chronic liver diseases, including HCC. The object of this study is to investigate the association between appendectomy and the risk of HCC.
Methods: We analyzed a cohort of 12864 patients who underwent appendectomy between 1998 and 2013 based on the Taiwan National Health Insurance Program database. A comparison cohort of 51456 persons without appendectomy was selected randomly and matched by sex, age, comorbidities, and index year. To ensure reliability of the results, a sensitivity analysis using a propensity score–matched study was performed. We observed the subsequent development of HCC in both cohorts.
Results: Although the overall incidence of HCC in the appendectomy patients was 8.7% higher than that in the non-appendectomy patients, it was not statistically significant (95% confidence interval [CI], 0.833–1.417) after the adjustment of confounding factors. Multivariable regression analysis revealed that the adjusted hazard ratio (HR) of HCC was 1.870 for the appendectomy patients at age< 40 years (95% CI 1.012, 3.454) compared to the non-appendectomy patients. The incidence of HCC was higher within 5 years of post-appendectomy follow-up than for the non-appendectomy patients (HR of 1.771, 95% CI, 1.143–2.674). Age affected the association between appendectomy and HCC risk (Pinteraction = 0.0207); in contrast, sex did not influence the association between appendectomy and HCC risk (Pinteraction = 0.5726).
Conclusions: The results of our study suggest that appendectomy increases HCC risk, particularly when executed before middle age.

Appendectomy, hepatocellular carcinoma (HCC), enteric microbiota

Cite this paper
Yang-Ming Lee, Chew-Teng Kor, Impact of age at appendectomy on development of HCC: A population-based cohort study , SCIREA Journal of Clinical Medicine. Volume 9, Issue 1, February 2024 | PP. 32-44. 10.54647/cm32404


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