慢性乙型肝炎患者的代谢危险因素与癌症和全因死亡率的关

StephenW

Association of Metabolic Risk Factors With Risks of Cancer and All-Cause Mortality in Patients With Chronic Hepatitis B
Yun Bin Lee  1 , Hyemi Moon  2 , Jeong-Hoon Lee  1 , Eun Ju Cho  1 , Su Jong Yu  1 , Yoon Jun Kim  1 , Fabien Zoulim  3 , Juneyoung Lee  2 , Jung-Hwan Yoon  1
Affiliations
Affiliations

    1
    Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
    2
    Department of Biostatistics, College of Medicine, Korea University, Seoul, Korea.
    3
    Cancer Research Centre of Lyon, INSERM U1052, Lyon University, Hospices Civils de Lyon, Lyon, France.

    PMID: 33140415 DOI: 10.1002/hep.31612

Abstract

Background and aims: Long-term antiviral therapy can effectively suppress viral replication and improve clinical outcomes in patients with chronic hepatitis B (CHB), but it cannot eliminate risk of hepatocellular carcinoma (HCC). We investigated the association of metabolic risk factors with the risks of cancer and all-cause mortality in CHB patients.

Approach and results: This nationwide population-based study from the Korean National Health Insurance Service database consisted of adults with CHB who underwent health examinations from 2007 through 2012. We collected baseline data on metabolic risk factors, including obesity, high blood pressure, hypercholesterolemia, and diabetes. The risks of developing HCC, non-HCC cancer, and overall death were analyzed according to the metabolic risk profile. The study population comprised of 317,856 patients (median age, 46 years [interquartile range, 37-54 years]; 219,418 men [69.0%]) had 2,609,523.8 person-years of follow-up. A total of 18,850 HCCs, 22,164 non-HCC cancers, and 15,768 deaths were observed during a median follow-up period of 8.5 years. The metabolic risk factor burden was positively associated with the risks of HCC, non-HCC cancer, and all-cause mortality (all P<.0001 for trend). Patients with ≥3 metabolic risk factors, compared to those without metabolic risk factors, showed adjusted hazard ratios of 1.23 (95% confidence interval [CI], 1.16-1.31) for HCC, 1.34 (95% CI, 1.27-1.41) for non-HCC cancer, and 1.31 (95% CI, 1.23-1.39) for all-cause mortality. Among patients receiving antiviral therapy for over 5 years, the risk-increasing association of the sum of metabolic risk factors with the risks of HCC and overall death was consistent.

Conclusion: The metabolic risk factor burden was associated with increased risks of HCC, non-HCC cancer, and all-cause mortality in patients with CHB.

Keywords: Hepatocellular carcinoma; Liver cancer; Malignancy; Metabolic syndrome; Survival.

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StephenW

慢性乙型肝炎患者的代谢危险因素与癌症和全因死亡率的关系
李允彬1，Hyemi Moon 2，李正勋1，Eun Ju Cho 1，Su Jong Yu 1，尹俊金1，Fabien Zoulim 3，李俊英2，郑焕焕1
隶属关系
隶属关系

    1个
    首尔国立大学医学院内科与肝脏研究所，韩国首尔。
    2
    高丽大学医学院生物统计学系，韩国首尔。
    3
    里昂大学癌症研究中心，INSERM U1052，里昂大学，里昂市政医院，法国里昂。

    PMID：33140415 DOI：10.1002 / hep.31612

抽象

背景与目的：长期抗病毒治疗可以有效抑制慢性乙型肝炎（CHB）患者的病毒复制并改善临床结局，但不能消除肝细胞癌（HCC）的风险。我们调查了CHB患者的代谢风险因素与癌症风险和全因死亡率的关系。

方法和结果：这项基于韩国国家健康保险服务数据库的全国性人群研究包括2007年至2012年接受健康检查的CHB成年人。我们收集了有关代谢风险因素的基线数据，包括肥胖，高血压，高胆固醇血症，和糖尿病。根据代谢风险概况分析了发生HCC，非HCC癌症和整体死亡的风险。研究人群包括317,856例患者（中位年龄46岁[四分位间距37-54岁]； 219,418名男性[69.0％]），随访时间为2,609,523.8人年。在8.5年的中位随访期内，共观察到18,850例HCC，22,164例非HCC癌症和15,768例死亡。代谢危险因素负担与HCC，非HCC癌症和全因死亡率的风险呈正相关（趋势的P均<0.0001）。与没有代谢危险因素的患者相比，具有≥3个代谢危险因素的患者对HCC的调整后危险比为1.23（95％置信区间[CI]，1.16-1.31），对于非肝细胞癌，调整后的危险比为1.34（95％CI，1.27-1.41） -HCC癌症，全因死亡率为1.31（95％CI，1.23-1.39）。在接受抗病毒治疗超过5年的患者中，代谢危险因素总和与HCC和总体死亡风险之间的风险增加关联是一致的。

结论：代谢危险因素负担与CHB患者HCC，非HCC癌症和全因死亡率增加有关。

关键词：肝细胞癌；肝癌;恶性;代谢综合征;生存。

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