Abstract
The association between metabolic syndrome (MS), both in terms of its components and as a whole, and the risk of hepatocellular carcinoma (HCC) in subjects with hepatitis B virus (HBV) infection remains unclear, especially in mainland China. We prospectively included 6,564 individuals with HBV infection from an initial cohort of 105,397 civil servants. The multivariate-adjusted HR and 95% confidence interval (95% CI) were evaluated using Cox proportional hazards models to explore the potential connection between HCC risk and MS. Cumulative incidences were plotted using Kaplan-Meier curves. After a 45,668.0 person-year follow-up (76.0 ± 30.8 months) of 6,564 subjects who were seropositive for hepatitis B surface antigen, 89 incident HCC cases were identified. MS as a whole was independently associated with a 2-fold increased HCC risk (HR, 2.25; 95% CI, 1.41-3.60) after adjusting for age (in 1-year increments), gender, cigarette smoking, alcohol consumption, liver cirrhosis, and elevated aspartate aminotransferase levels (≥40 U/L). Subjects with three or more factors and those with one or two factors had adjusted increased HCC risks of 2.12-fold (95% CI, 1.16-3.89) and 1.28-fold (95% CI, 0.74-2.22), respectively, in comparison with those without any metabolic factors. Central obesity and type 2 diabetes were associated with significantly increased HCC risk, whereas this association was not observed in obese subjects (body mass index ≥30 kg/m2; 95% CI, 0.73-3.44). MS as a whole, central obesity, and type 2 diabetes were independently associated with increased HCC risk in a population with HBV infection in mainland China. MS may be a risk factor for HCC.
Highlights
Hepatitis B or C virus (HBV/HCV) infections [1] are wellknown risk factors for hepatocellular carcinoma (HCC), and epidemiologic research has identified a multitude of other factors, including heavy alcohol consumption, obesity [3], type 2 diabetes [4, 5], and tobacco smoking [6].Viral infection in HCC cases was commonly observed to be copresent with other etiologic factors of this malignancy [6,7,8]
metabolic syndrome (MS) as a whole, central obesity, and type 2 diabetes were independently associated with increased HCC risk in a population with hepatitis B virus (HBV) infection in mainland China
During the 45,668.0 person-year follow-up of 6,564 subjects who were seropositive for HBsAg, 89 incident HCC cases were identified; 45 of these cases were verified with postoperative histological pathology, and 1 was verified with biopsy
Summary
Hepatitis B or C virus (HBV/HCV) infections [1] are wellknown risk factors for hepatocellular carcinoma (HCC), and epidemiologic research has identified a multitude of other factors, including heavy alcohol consumption Viral infection in HCC cases was commonly observed to be copresent with other etiologic factors of this malignancy [6,7,8]. It has been reported that in areas with a high prevalence of hepatitis. Note: Supplementary data for this article are available at Cancer Epidemiology, Biomarkers & Prevention Online (http://cebp.aacrjournals.org/). The association between metabolic syndrome (MS), both in terms of its components and as a whole, and the risk of hepatocellular carcinoma (HCC) in subjects with hepatitis B virus (HBV) infection remains unclear, especially in mainland China
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