Risk Factors for Hepatocellular Carcinoma in a Cohort Infected With Hepatitis B

StephenW

http://www.medscape.com/viewarticle/755453
From Journal of Gastroenterology and Hepatology
Risk Factors for Hepatocellular Carcinoma in a Cohort Infected With Hepatitis B or C

Scott R Walter; Hla-Hla Thein; Heather F Gidding; Janaki Amin; Matthew G Law; Jacob George; Gregory J Dore

Authors and Disclosures

Posted: 12/28/2011; J Gastroenterol Hepatol. 2011;26(12):1757-1764. © 2011 Blackwell Publishing



Abstract

Background and Aim: The incidence of hepatocellular carcinoma (HCC) has increased in Australia in recent decades, a large and growing proportion of which occurs among a population chronically infected with hepatitis B virus (HBV) or hepatitis C virus (HCV). However, risk factors for HCC among these high-risk groups require further characterization.
Methods: We conducted a population-based cohort study using HBV and HCV cases notified to the New South Wales Health Department between 2000 and 2007. These were linked to cause of death data, HIV/AIDS notifications, and hospital records. Proportional hazards regression was used to identify significant risk factors for developing HCC.
Results: A total of 242 and 339 HCC cases were linked to HBV (n = 43 892) and HCV (n = 83 817) notifications, respectively. For both HBV and HCV groups, being male and increasing age were significantly associated with risk of HCC. Increasing comorbidity score indicated high risk, while living outside urban areas was associated with lower risk. Hazard ratios for males were two to three times those of females. For both HBV and HCV groups, cirrhosis, alcoholic liver disease, and the interaction between the two were associated with significantly and considerably elevated risk.
Conclusion: This large population-based study confirms known risk factors for HCC. The association with older age highlights the potential impact of HBV and HCV screening of at-risk groups and early clinical assessment. Additional research is required to evaluate the impact of improving antiviral therapy on HCC risk.
Introduction

Hepatocellular carcinoma (HCC) is one of the leading causes of cancer incidence and mortality worldwide.[1–3] Although less common in Australia than other regions, there has been a marked increase in HCC incidence in recent decades.[4–6] Chronic infection with hepatitis B virus (HBV) or hepatitis C virus (HCV) is the main risk factor for HCC,[7,8] with over 80% of cases worldwide developing in the presence of these infections.[9] The increasing prevalence of chronic viral hepatitis in Australia has been identified as a key driver behind the rising incidence of HCC.[10,11] Other known HCC risk factors include cirrhosis, alcoholic liver disease (ALD), aflatoxin B1,[12] hemochromatosis,[8] HIV,[13] diabetes,[14–16] and HBV/HCV co-infection.[17–20] Increasing age, being male,[21] and certain ethnicities[22] have also been identified as risks, along with lifestyle factors, such as high alcohol intake and smoking. The prevalence of risk factors can vary considerably between geographical regions.[21]

Many published studies have examined risk factors for HCC in various regions of the world,[8,21,23–26] some of which have looked at risk within HBV- or HCV-infected groups.[23–25] However, there are very few studies of HCC risks in the Australian context,[10] and none which quantify risk among HBV- or HCV-infected people at a population level. To this end, we conducted a population-based, retrospective cohort study to identify and quantify risk factors for HCC among an already high-risk group of HBV or HCV infected individuals in New South Wales (NSW), Australia's most populous state.

StephenW

胃肠病学和肝病学杂志
肝细胞癌的危险因素在B或C型肝炎感染世代

ř沃尔特斯科特; HLA - HLA登;希瑟F吉丁;萨拉萨阿明;马修摹法;雅各布乔治格雷戈里J多尔


发表于：2011年12月28日;胃肠肝胆病。 2011，26（12）:1757 - 1764。 © 2011布莱克韦尔出版


摘要

背景和目的：肝细胞癌（HCC）的发生率增加在澳大利亚近几十年来，其中的一个庞大且不断增长的比例之间发生慢性乙型肝炎病毒（HBV）或丙型肝炎病毒（HCV）感染人口。然而，这些高危人群中肝癌的危险因素，需要进一步鉴定。
方法：我们进行了一项基于人群的队列研究使用乙型肝炎和丙型肝炎案件，2000年和2007年间，新南威尔士州卫生署通知。这些被挂造成的死亡数据，艾滋病毒/艾滋病问题的通知，和医院的记录。比例风险回归被用来确定肝癌发展的显著风险因素。
结果：共有242和339例肝癌与乙型肝炎病毒（N = 43 892）和丙型肝炎病毒（N = 83 817）的通知，分别。对于乙型肝炎和丙型肝炎组，男性和年龄的增加均显着相关，与肝癌的风险。增加合并症得分表示高风险，而市区以外的生活是风险较低。危害比男性的两到三倍的女性。对于乙型肝炎和丙型肝炎组，肝硬化，酒精性肝病，以及两者之间的互动与显著，并大大升高的风险。
结论：这个人口众多基于的研究证实，肝癌已知的危险因素。与老年协会强调，乙型肝炎和丙型肝炎的高危人群的筛查和早期临床评估的潜在影响。需要更多的研究评估，提高抗病毒治疗肝癌的风险的影响。
简介

肝细胞癌（HCC）是癌症的发病率和死亡率全球领先的原因之一[1-3]虽然在澳大利亚普遍高于其他地区，已在近几十年来，在肝癌的发病率明显增加[4-6]。与乙型肝炎病毒（HBV）或丙型肝炎病毒（HCV）慢性感染是肝癌的主要危险因素，超过80％的情况下，全球发展中存在的这些感染[7,8]。[9]的患病率增加慢性病毒性肝炎在澳大利亚已被确定为肝癌的发病率不断上升背后的一个关键驱动。[10,11]其他已知肝癌的危险因素包括肝硬化，酒精性肝病（ALD），黄曲霉毒素B1，[12]血色病，[8 ]艾滋病毒，[13]糖尿病[14-16]和HBV / HCV合并感染。[17-20]年龄的增加，正男，[21]和某些种族[22]也已确定风险，沿与生活方式的因素，如高饮酒和吸烟。危险因素的患病率会有所不同地理区域很大。[21]

许多发表的研究肝癌的研究，在世界各地区的危险因素，[8,21,23-26]其中有一些风险看着内乙型肝炎病毒或丙型肝炎病毒感染的群体。[23-25​​]然而，也有在澳大利亚的情况下肝癌风险的研究很少，[10]和无量化乙型肝炎病毒或丙型肝炎病毒感染的人之间的人口水平的风险。为此，我们进行了以人群为基础，回顾性队列研究，以确定和量化肝癌的危险因素之间HBV或HCV感染，澳大利亚人口最多的州 - 新南威尔士州（NSW）的的个人已经高危险群。