Liver Cancer is 'Largely Amenable to Primary Prevention'

StephenW

October 27, 2011 — "Hepatocellular carcinoma, one of the most lethal human cancers, is largely amenable to primary prevention with existing knowledge and technology," according to American researchers. They report a study showing strong links between liver cancer  and the modifiable risk factors of smoking, heavy alcohol consumption, and obesity, and between liver cancer and chronic infection with hepatitis B and C.
The findings, from a team led by Dimitrios Trichopoulos, MD, PhD, from the Department of Epidemiology at the Harvard School of Public Health, Boston, Massachusetts, were published online October 21 in the Journal of the National Cancer Institute.
The data come from the European Prospective Investigation Into Cancer and Nutrition (EPIC), a study that followed about 500,000 individuals from 1992 to 2000 in 10 countries in Europe. From this database, Dr. Trichopoulos and colleagues identified 115 patients with hepatocellular carcinoma, and matched them with 229 control subjects.
Investigators found that the highest risk factors for liver cancer were chronic hepatitis B infection (odds ratio [OR], 9.10) and chronic hepatitis C infection (OR 13.36), followed by obesity (OR, 2.13), former or current smoking (OR, 1.98 and 4.55, respectively), and heavy alcohol intake (OR, 1.77).
                        Smoking a Major Contributor                    
The researchers highlight smoking in particular. In this European cohort, smoking was associated with more hepatocellular carcinoma than chronic hepatitis infections.
Smoking contributed to almost half of all liver cancer cases (47.6%), whereas chronic hepatitis B and C infections contributed 13.2% and 20.9% respectively, they report. Obesity contributed to 16.1% of cancer cases, and heavy alcohol intake contributed to 10.2%.
When taken together, these documented risk factors accounted for 65.7% of all liver cancer in the European cohort.
An accompanying editorial also highlights the "remarkable and controversial" finding that smoking increases the risk for liver cancer.
"Somewhat surprisingly, smoking carried an attributable risk of almost 50%, a figure that challenges our current knowledge," write editorialists Morris Sherman, MD, and Joseph Llovet, MD, both from the Mount Sinai School of Medicine in New York City.

                                                    These data are compelling and we should take note.                                            

Although they outline some limitations to the study — including the fact that smoking was reported in more than twice as many patients with liver cancer as in control subjects — they say: "These data are compelling and we should take note."
"We should be counseling our patients who have other risk factors for hepatocellular carcinoma to quit smoking," they write.
"There are many other health reasons to stop smoking," they acknowledge, adding: "Here is one more."
                        The authors have disclosed no relevant financial relationships.                    
                        J Natl Cancer Inst. Published online October 21, 2011. Abstract, Editorial                    

StephenW

2011年10月27日 - “肝癌，人类最致命的癌症之一，主要是适合初级预防与现有的知识和技术，”根据美国的研究人员。他们报告的一项研究显示肝癌和改变的危险因素，吸烟，酗酒和肥胖之间的紧密联系，并与乙型和丙型肝炎，肝癌和慢性感染

结果，从迪米特里奥斯Trichopoulos，博士，在美国哈佛大学公共卫生，马萨诸塞州的波士顿，学院流行病学系领导一个团队，发表在国家癌症研究所杂志“在线10月21日。

来自欧洲前瞻性癌症与营养调查（EPIC）的一项研究，大约50个人从1992年至2000年在欧洲10个国家的数据。从这个数据库中，Trichopoulos博士和他的同事发现了115例肝癌患者，和229个对照组相匹配。

调查发现，最高为肝癌的风险因素是慢性乙肝病毒感染（胜算比[OR]，9.10）和慢性丙型肝炎病毒感染（13.36），肥胖（OR，2.13），前任或现任吸烟（OR，分别为1.98和4.55），和重型酒精的摄入量（OR，1.77）。

吸烟的主要贡献者

研究人员特别突出吸烟。在这个欧洲的人群中，吸烟是与以上的慢性乙型肝炎感染的肝癌。

吸烟导致几乎所有肝癌病例（47.6％）的一半，而慢性乙型和丙型肝炎感染的贡献分别为13.2％和20.9％，他们的报告。肥胖导致的癌症病例的16.1％，重酒精的摄入量作出了贡献10.2％。

当两者合计，这些风险因素占所有在欧洲人群的肝癌中的65.7％。

随后的社论中还强调了“显着，备受争议的”发现，吸烟会增加肝癌的风险。

“有点令人惊讶的是，吸烟进行了近50％的占风险，这个数字是挑战我们现有的知识，”写社论莫里斯谢尔曼，医学博士，和约瑟夫Llovet，医学博士，在纽约市西奈山医学院。

这些数据是令人信服的，我们应该注意。

虽然他们的轮廓一定的局限性的研究 - 包括报道，在对照组的两倍以上肝癌患者是吸烟的事实 - 他们说：“这些数据是令人信服的，我们应该注意。”

“我们应该辅导我们的病人有肝癌的其他危险因素，戒烟，”他们写道。

“有许多其他健康原因停止吸烟，”他们也承认，并说：“这里是一个更”

作者宣告没有相关财务关系。

J Natl癌症研究所。在网上公布2011年10月21日。摘要编辑