(SLB-049) Assessment Of Arsenic and Heavy Metal Contamination in Gallbladder Cancer: Carcinogenic Risk and Implications For DALY, Quality of Life, and Treatment Survival

Background: Northeast India reports among the highest global incidences of gallbladder cancer (GBC), with arsenic-contaminated drinking water hypothesized as a potential etiological factor. This study investigates heavy metal contamination in GBC patients and explores its implications for carcinogenesis, disability-adjusted life years (DALY), quality of life (QoL), and treatment survival.

Objectives: To quantify arsenic and other heavy metal levels in GBC patients, assess their carcinogenic risk, and investigate associations with QoL and survival outcomes.

Methods: We conducted a hospital-based observational cohort study in a tertiary care cancer specialty hospital in northeast India. Using inductively coupled mass spectrometry (ICPMS), an Agilent 7800, arsenic (As), and other 11 trace elements were measured in urine (n=216) and drinking water (n=97) collected from histopathologically confirmed GBC patients. The USEPA model was used to assess cancer and non-cancer risks. The Incremental Lifetime Cancer Risk (CR) and Hazard Quotient (HQ) were used to determine cancerous and non-cancerous risk levels in patients with GBC. Quality of life was assessed using validated tools: EORTC QLQ-C30, EORTC BIL-21, and EQ-5D-5L. Associations between urinary metal concentrations, QoL scores, and survival outcomes were analysed using multivariate regression and Cox proportional hazards models.

Results: The mean concentrations (ppb) of As (20.59±2.09), Se (78.49±17.95), Sr (82.05±7.08), and Cd (4.86±0.65) exceeded the WHO limit in urine samples of GBC patients. About 61.3% of water samples exceeded the WHO limit for As in their drinking water. The health risk assessment shows that the exposed concentration of As, Cr, Ni, and Cd in the urine samples can cause cancer risk with CR values of 0.001, 0.001, 0.000089, and 0.0012, respectively. The As, Cr, Ni, and Cd (CR: 0.00007, 0.0003, 0.00044, and 0.00001, respectively) had cancer risk with the exposed concentration in their drinking water. There was a strong positive correlation in arsenic concentrations between water and urine (R2=0.84). The QoL of GBC patients at the baseline obtained from QLQ-C30, BIL-21, and visual analogue scale were 0.46±0.07, 0.33± 0.50, and 47.13±29.49 respectively. From the component scale analysis of BIL-21, the baseline QoL of the patient is affected by pain, anxiety, tiredness, and eating (0.54, 0.47, 0.45, and 0.45 respectively).

Conclusions: Chronic arsenic and heavy metal exposure in GBC patients correlates with substantial carcinogenic risk. Analysis linking metal concentrations to QoL, DALY, and treatment survival is ongoing. These findings underscore the need for holistic environmental and clinical interventions to mitigate regional GBC burden.