Risk factors for hepatocellular carcinoma in a cohort infected with hepatitis B or C
Article first published online: 21 NOV 2011
© 2011 Journal of Gastroenterology and Hepatology Foundation and Blackwell Publishing Asia Pty Ltd
Journal of Gastroenterology and Hepatology
Volume 26, Issue 12, pages 1757–1764, December 2011
How to Cite
Walter, S. R., Thein, H.-H., Gidding, H. F., Amin, J., Law, M. G., George, J. and Dore, G. J. (2011), Risk factors for hepatocellular carcinoma in a cohort infected with hepatitis B or C. Journal of Gastroenterology and Hepatology, 26: 1757–1764. doi: 10.1111/j.1440-1746.2011.06785.x
- Issue published online: 21 NOV 2011
- Article first published online: 21 NOV 2011
- Accepted manuscript online: 26 MAY 2011 06:00AM EST
- Accepted for publication 12 May 2011.
- hepatitis B;
- hepatitis C;
- hepatocellular carcinoma
Background and Aim: The incidence of hepatocellular carcinoma (HCC) has increased in Australia in recent decades, a large and growing proportion of which occurs among a population chronically infected with hepatitis B virus (HBV) or hepatitis C virus (HCV). However, risk factors for HCC among these high-risk groups require further characterization.
Methods: We conducted a population-based cohort study using HBV and HCV cases notified to the New South Wales Health Department between 2000 and 2007. These were linked to cause of death data, HIV/AIDS notifications, and hospital records. Proportional hazards regression was used to identify significant risk factors for developing HCC.
Results: A total of 242 and 339 HCC cases were linked to HBV (n = 43 892) and HCV (n = 83 817) notifications, respectively. For both HBV and HCV groups, being male and increasing age were significantly associated with risk of HCC. Increasing comorbidity score indicated high risk, while living outside urban areas was associated with lower risk. Hazard ratios for males were two to three times those of females. For both HBV and HCV groups, cirrhosis, alcoholic liver disease, and the interaction between the two were associated with significantly and considerably elevated risk.
Conclusion: This large population-based study confirms known risk factors for HCC. The association with older age highlights the potential impact of HBV and HCV screening of at-risk groups and early clinical assessment. Additional research is required to evaluate the impact of improving antiviral therapy on HCC risk.