Synergistic effects of different types of smoking and other risk factors on risk of hepatocellular carcinoma in Xiamen, China

Abstract

To evaluated the independent effects of different types of smoking exposure along with multiple risk factors for hepatocellular carcinoma (HCC) and determined whether the magnitude of smoking was modified by other risk factors, both in men and women. We conducted a case-control study in Xiamen China. 345 HCC patients and 961 healthy control subjects were personally interviewed for several HCC risk factors. Multivariate logistic regression analysis was performed to estimate the adjusted odds ratio (AOR) and 95% confidence interval (CI) for each potential risk factor. Cigars and pipes were not related to HCC among non-cigarette smokers. However, passive smoking exposure was associated with HCC in women: AOR, 2.35 (95%CI: 1.19 - 4.07). Regular cigarette smoking was associated with HCC in men: AOR, 2.27 (95%CI: 1.14 - 3.31). Cigarette smoking and chronic infection of hepatitis B virus showed positive additive model interactions in men: RERI (relative excess risk due to interaction) was 98.70 and AP (attributable proportion due to interactions) was 81.0%. Data on cigarette smoking with high AFB1-albumin adducts in women showed that the RERI was 2.69 and AP was 50.0%. We concluded that sex differences were seen in HCC relationship with cigarette smoking. Controlling of exposure to smoking might be a prudent approach to the prevention of HCC, especially in patients with chronic viral hepatitis infections.