High metabolic risk factor burden ups HCC risk in HBV carriers
A high burden of metabolic risk factors may increase the risk of hepatocellular carcinoma (HCC) in men with chronic hepatitis B virus (HBV) infection, a study has shown. Importantly, smoking exerts a significant effect on the said association.
To analyse the effects of HBV factors on HCC risk, based on metabolic factors and insulin resistance, researchers examined the medical records of 5,373 adult males who received routine free physical examinations from 1989 through 1992.
Data on liver-related morbidity and mortality in HBV carriers, with different metabolic risk factors, were available for 1,690 men aged 40 to 65 years. Medical histories of these HBV carriers were evaluated against those of study participants without HBV or HCV infection in the same age range (n=1,289). Baseline data on obesity, diabetes, hypertriglyceridemia and high blood pressure were used to assign participants to metabolic risk categories.
Over median follow-up period of 19 years, a total of 158 HBV carriers developed HCC and 126 died from liver-related diseases. In comparison, only six developed HCC or died from liver-related disease among participants without HBV or HCV infection.
Cumulative incidence of HCC and liver-related death varied significantly among HBV carriers with different metabolic risk factors. Specifically, patients with ≥3 metabolic risk factors had a markedly higher HCC risk compared with those who had a low metabolic risk profile (10-year cumulative incidence, 13.60 vs 4.83 percent; adjusted-hazard ratio [aHR], 2.32; 95 percent CI, 1.18 to 4.54).
Moreover, smoking had a significant effect on the association between HCC risk and metabolic risk factors (p=0.0044 for interaction). Compared with the absence of any factors, having ≥3 metabolic risk factors significantly increased the risk of HCC (aHR, 5.06; 2.23 to 11.47) and 10-year cumulative HCC incidence in smokers (25 percent in smokers with ≥3 metabolic risk factors vs 3.87 percent in smokers with none; p<0.0001). The presence of ≥3 metabolic risk factors did not increase HCC risk in nonsmokers.
In patients with levels of HBV-DNA <10,000 copies/mL, metabolic risk factors and insulin resistance showed the greatest effect on HCC risk.