Chronic hepatitis C increased the mortality rates of patients with hepatocellular carcinoma and diabetes mellitus in a triple hepatitis virus endemic community.
ABSTRACT To elucidate the factors associated with mortality rates among older subjects with hepatocellular carcinoma (HCC) and diabetes mellitus (DM) in a triple hepatitis B virus (HBV), hepatitis C virus (HCV) and hepatitis delta virus (HDV) endemic community.
A total of 2,909 residents aged>or=45 years were screened for hepatitis B surface antigen (HBsAg), antibodies to HCV (anti-HCV) and alanine aminotransaminase (ALT) in 1997. Anti-HDV was detected in HBsAg-positive subjects. Those who expired from HCC and DM were identified from official mortality data sets (1997-2003). Survival was analyzed using the Kaplan-Meier survival curve with log-rank test and the Cox proportional hazard model.
Forty-one patients died of HCC and 25 of DM during the study period. Multivariate analysis indicated that age>or=65 years (hazard ratio 3.4; 95% confidence interval 1.8-6.4), HBsAg (3.3; 1.7-6.7), anti-HCV (3.8; 1.7-8.5) and ALT>or=40 IU/L (3.7; 1.9-7.0) were independent predictors of HCC mortality, while age>or=65 years (4.8; 2.1-11.0) and anti-HCV (4.2; 1.7-10.6) were two independent predictors of DM mortality. There were synergistic effects of dual viral infections for HCC, but not for DM mortality.
Old age and chronic HCV infection increase the risk of HCC and DM mortality. HBsAg and ALT levels are also risk factors for HCC mortality, but not DM. The synergistic effects of dual hepatitis viral infections are demonstrable and warrant further investigation.
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ABSTRACT: The majority of data on risk factors (RFs) for hepatocellular carcinoma (HCC) comes from studies involving populations without underlying liver disease. It is important to evaluate RFs for HCC in patients with chronic liver disease since HCC rarely occurs in those without underlying liver disease. We conducted a hospital-based case-control study of 259 incident HCC cases and 781 controls by convenience sampling between 02/2001 and 12/2009 from the liver clinic at Stanford University Medical Center. The study population was 41% White, 14% Hispanic, 3% African American, 40% Asian American, and 2% other race/ethnicity. RFs were examined through medical records and an in-person questionnaire. Alcohol and tobacco use was calculated by cumulative grams of alcohol or cumulative pack(s) of cigarette consumed over one's lifetime. Diabetes mellitus (DM) was defined by random glucose level of ≥200 mg/dL. RFs were evaluated using multivariate logistic regression. Independent predictors of HCC risk, after mutual adjustment and additional control for alcohol use, etiology of liver diseases, and DM, included age >40 (OR = 8.5 [2.6-28.3]), male gender (OR = 3.5 [2.2-5.8]), presence of cirrhosis (OR = 2.8 [1.6-4.9]), Asian ethnicity (OR = 2.8 [1.8-4.6]), AFP > 50 (OR = 4.2 [2.6-6.8]), and cumulative lifetime tobacco use of >11,000 packs (OR = 1.7 [1.0-2.9]). Heavy prolonged cigarette smoking, but not alcohol use, was a significant independent predictor for HCC in patients with underlying liver disease. Besides older age, male gender, presence of cirrhosis, and elevated AFP, Asian ethnicity and heavy cumulative tobacco use are strong independent predictors of HCC.Cancer Causes and Control 03/2012; 23(3):455-62. DOI:10.1007/s10552-012-9895-z · 2.96 Impact Factor
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ABSTRACT: The possibility has been raised in a number of cohort and case-control studies that diabetes mellitus (DM) may increase the risk of liver cancer, as well as that of cancer at other sites. To verify this possibility, we conducted a retrospective cohort study to determine the prevalence of type 2 DM in Japanese patients with hepatocellular carcinoma (HCC). A total of 1,251 patients with HCC, diagnosed at two major liver centers in the Nagasaki area, were consecutively recruited and categorized according to the etiology of HCC into four groups: HCC-B, HCC-C, HCC-BC and HCC-nonBC cases. Type 2 DM was diagnosed on the basis of standard criteria. The prevalence rate of HCC-nonBC and HCC-C was significantly higher than that of HCC-B, while the prevalence rate of HCC-nonBC was significantly higher than that of HCC-C. The prevalence of type 2 DM in HCC-B, HCC-C and HCC-nonBC patients under 66 years of age was 11, 31 and 32%, respectively, vs. 24, 22 and 40%, respectively, in patients over 66 years of age. In patients over 66 years of age, the prevalence of type 2 DM in HCC-B and HCC-nonBC cases was increased, whereas the prevalence of type 2 DM in HCC-C cases was significantly decreased. Our findings indicate that the effects of the interaction between type 2 DM and HCV increase the prevalence of HCC.Experimental and therapeutic medicine 01/2011; 2(1):81-84. DOI:10.3892/etm.2010.167 · 0.94 Impact Factor
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ABSTRACT: Background: Risk factors associated with HCC are well documented, but the synergism between these risk factors are not well examined. The aim of this study was to detect the effect of synergism of two or more risk factors on the development of HCC. Patients & methods: This is a retrospective study of the risk factors of HCC in 300 patients with HCC and 50 patients with chronic liver diseases without HCC as controls. All patients were interviewed about smoking, drinking and family history of HCC. They underwent laboratory investigations (HCVAb, HBsAg, Alpha-fetoprotein and HCV PCR), abdominal ultrasonography and Triphasic CT. Results: Prevalence rate of DM and smoking was significantly higher in HCC cases (59.3% and 69% respectively) than controls (38% and 50% respectively)(P=0.005 and 0.006 respectively). The prevalence of HBsAg and HCVAb was significantly higher in HCC cases (18% and 70% respectively) than controls (4% and 40% respectively)( P =0.02 and 0.0001 respectively). On multivariate analysis, the risk of HCC development in smokers with HBV or HCV was 4.90 and 8.47 respectively (OR) (P =0.0001). It was higher than in non-smokers with HBV or HCV (OR=2.48 and 4.44 respectively)( P =0.037 and 0.0001 respectively) and in smokers without HBV or HCV (OR=2.56 and 2.77 respectively) (P =0.01). The risk of HCC development in HBV or HCV positive patients with DM was 3.98 and 9.19 respectively (OR) (P =0.001 and 0.0001 respectively). It was higher than for HBV or HCV positive patients without DM (OR=2.80 and 4.65 respectively)( P =0.031 and 0.0001 respectively) and that for HBV or HCV negative patients with DM (OR=2.56 and 2.23 respectively)( P =0.011and 0.0001 respectively).Conclusion, HCV and HBV infections, diabetes and smoking are the main determinants of HCC development in Egypt. There is a synergistic effect of many risk factors. An active surveillance and secondary prevention programs for patients with chronic hepatitis are the most important steps to reduce the risk of HCC.American Journal of Science 04/2013; 9(4):211-217. · 3.93 Impact Factor