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Background
Gallbladder cancer (GBC) is a rare, highly fatal disease with diagnosis in advanced stage and low survival rate. Nepal ranked 4th position with highest rates of GBC for 10 countries in 2020.
Objective
To find the association between socio-demographic, behavioral and environmental factors associated with the development of GBC.
Method
A case-control study was conducted in 2021/22 with newly diagnosed gallbladder cancer cases from three cancer-specialized hospitals and one tertiary (superspeciality) hospital. Controls were selected from the same tertiary hospital and one additional hospital providing services to gallbladder pathologies for a huge population, making a total of five hospitals involved in the study. The ratio of cases to control was 1:1. The data collection was done through telephonic interviews using structured questionnaires. The risk factors for GBC were assessed by using unconditional logistic regression to find odds ratios and 95% confidence level for bivariate and multivariate analysis. The statistical analysis was carried out in STATA 18.
Result
A total of 240 respondents were enrolled in the study, among them half were GBC patients (cases) and half were gallbladder patients (controls). The average age of the respondents was 54.82±12.3 years, with female preponderance among both groups. On multivariate analysis, the risk factors studied were; parity ≥3 (AOR = 2.80, 95% CI: 1.17–6.66, P value 0.020), being ethnic group of Terai/Madhesi (AOR = 7.88, 95% CI: 3.16–19.66, P value <0.001), being Janajati (AOR = 3.36, 95% CI: 1.17–6.61, P value <0.001), having gallbladder related disease (AOR = 2.00, 95% CI:1.00–4.02, P value 0.049), consuming alcohol ≥100ml/day (AOR = 3.44, 95% CI:1.11–10.63, P value 0.032), exposed with pesticides ≥2 times in a year (AOR = 4.04, 95% CI: 1.27–12.89, P value 0.018) and consuming less vegetables and fruits (<1 times per day in a week) (AOR = 2.69, 95% CI:1.34–5.40, P value 0.005).
Conclusion
The study reveals key GBC risk factors, offering vital insights for targeted screening, resource allocation, and public health measures to mitigate risks in Nepal.

## 背景
胆囊癌（Gallbladder cancer, GBC）是一种罕见且致死率极高的疾病，确诊时多已处于晚期，生存率较低。2020年，在全球10个胆囊癌发病率最高的国家中，尼泊尔位列第四。

## 研究目的
旨在探究与胆囊癌发病相关的社会人口学、行为学及环境因素之间的关联。

## 研究方法
本研究于2021/2022年开展病例对照研究，研究对象来自3家肿瘤专科医院及1家三级（超专科）医院的新确诊胆囊癌患者。对照人群选自同一家三级医院及另一家服务于大量胆囊疾病患者的医院，本研究共涉及5家医院。病例与对照的配比为1:1。数据收集采用结构化问卷通过电话访谈完成。本研究采用非条件logistic回归分析评估胆囊癌的危险因素，通过双变量及多变量分析计算比值比（odds ratio, OR）与95%置信区间（confidence interval, CI），统计学分析使用STATA 18软件完成。

## 研究结果
本研究共纳入240名研究对象，其中一半为胆囊癌患者（病例组），另一半为胆囊疾病患者（对照组）。研究对象的平均年龄为54.82±12.3岁，两组女性占比均更高。经多变量分析，本研究识别的危险因素包括：产次≥3次（调整后比值比[AOR]=2.80，95%置信区间[CI]:1.17~6.66，P=0.020）、德赖/马德西族裔（AOR=7.88，95%CI:3.16~19.66，P<0.001）、贾纳贾蒂族裔（AOR=3.36，95%CI:1.17~6.61，P<0.001）、合并胆囊相关疾病（AOR=2.00，95%CI:1.00~4.02，P=0.049）、每日饮酒量≥100ml（AOR=3.44，95%CI:1.11~10.63，P=0.032）、每年接触农药≥2次（AOR=4.04，95%CI:1.27~12.89，P=0.018）以及蔬菜和水果摄入不足（每周内日均摄入<1次，AOR=2.69，95%CI:1.34~5.40，P=0.005）。

## 研究结论
本研究明确了胆囊癌的关键危险因素，可为尼泊尔开展针对性筛查、优化资源配置及制定公共卫生干预措施以降低发病风险提供重要参考。