Hepatitis B virus infection adds lymphoma burden in Korea

Abstract

Recently, Shin et al. published a study of the cancer burden in Korea attributable to infectious agents, among which hepatitis B virus (HBV) and hepatitis C virus (HCV) accounted for 29.9% of the cases and 46.5% of the deaths [1.Shin A. Park S. Shin H.R. et al.Population attributable fraction of infection-related cancers in Korea.Ann Oncol. 2011; 22: 1435-1442doi:10.1093/annonc/mdq592Abstract Full Text Full Text PDF PubMed Scopus (44) Google Scholar]. While they restricted the analysis to group 1 carcinogens defined by the International Agency for Research on Cancer, and cancers for which there is sufficient evidence in humans, including hepatocellular carcinoma for HBV and hepatocellular carcinoma and non-Hodgkin's lymphoma (NHL) for HCV, they extended the analysis to cholangiocarcinoma, for which there is limited evidence. Here, we suggest that the HBV may account for additional NHL burden in Korea. The association of HBV and NHL has been clearly shown by a large-scale cohort study [2.Engels E.A. Cho E.R. Jee S.H. Hepatitis B virus infection and risk of non-Hodgkin lymphoma in South Korea: a cohort study.Lancet Oncol. 2010; 11: 827-834doi:10.1016/S1470-2045(10)70167-4Abstract Full Text Full Text PDF PubMed Scopus (166) Google Scholar] and a number of case–control studies in Korean population [3.Kim J.H. Bang Y.J. Park B.J. et al.Hepatitis B virus infection and B-cell non-Hodgkin's lymphoma in a hepatitis B endemic area: a case–control study.Jpn J Cancer Res. 2002; 93: 471-477doi:10.1111/j.1349-7006.2002.tb01280.xCrossref PubMed Scopus (102) Google Scholar, 4.Park S.C. Jeong S.H. Kim J. et al.High prevalence of hepatitis B virus infection in patients with B-cell non-Hodgkin's lymphoma in Korea.J Med Virol. 2008; 80: 960-966doi:10.1002/jmv.21168Crossref PubMed Scopus (66) Google Scholar, 5.Kang J. Cho J.H. Suh C.W. et al.High prevalence of hepatitis B and hepatitis C virus infections in Korean patients with hematopoietic malignancies.Ann Hematol. 2011; 90: 159-164doi:10.1007/s00277-010-1055-5Crossref PubMed Scopus (60) Google Scholar]. Our recent retrospective analysis involving 3932 NHL cases and 15 562 controls showed that HBV infection increased the risks not only of B-cell lymphomas, but also of most subtypes of T/NK-cell lymphomas, Hodgkin's lymphoma and acute myeloid leukemia, while the association of HCV was more restricted, notably with diffuse large B-cell lymphoma, extranodal marginal zone lymphoma and peripheral T-cell lymphoma [5.Kang J. Cho J.H. Suh C.W. et al.High prevalence of hepatitis B and hepatitis C virus infections in Korean patients with hematopoietic malignancies.Ann Hematol. 2011; 90: 159-164doi:10.1007/s00277-010-1055-5Crossref PubMed Scopus (60) Google Scholar]. HBV-associated cases far outnumbered HCV-associated cases by a ratio of 4.3. As noted by Shin et al., the rapidly decreasing prevalence of HBV in the young age group in recent years demonstrates the effectiveness of the nationwide vaccination program, with the prospect of decrease in HBV-associated cancers in the future. However, the incidental cases of malignant lymphoma reflect the decades of HBV carriage, and we are in for the carry-over effect of the endemic level of HBV prevalence of the past century. Therefore, it is important to bear in mind that HBV infection may be associated with a wide variety of hematologic malignancies in regions with high HBV prevalence such as Korea, and to use the prophylactic antiviral therapy during and after chemotherapy to prevent HBV reactivation. The authors declare no conflicts of interest.