Elsevier

Journal of Hepatology

Volume 58, Issue 4, April 2013, Pages 730-735
Journal of Hepatology

Research Article
Heavy alcohol consumption increases the incidence of hepatocellular carcinoma in hepatitis B virus-related cirrhosis

https://doi.org/10.1016/j.jhep.2012.11.045Get rights and content

Background & Aims

Taiwan has a high prevalence of hepatitis B viral (HBV) infection and hepatocellular carcinoma (HCC) with increasing consumption of alcohol. We investigated the impact of heavy alcohol consumption and HBV infection on HCC in cirrhotic patients.

Methods

966 cirrhotic patients (132 with HBV infection and alcoholism, 632 with HBV infection, and 202 patients with alcoholism) were enrolled between 2000 and 2009 and followed until 2011. The primary end point was newly developed HCC.

Results

Within the three patient groups (cirrhotic patients with HBV infection and alcoholism, HBV infection alone, and alcoholism alone) 38 (28.8%), 100 (15.8%), and 21 (10.4%) showed newly developed HCC, respectively. The 10-year cumulative (52.8% vs. 39.8% vs. 25.6%, p <0.001) and annual incidences (9.9%, 4.1%, and 2.1%) of HCC were significantly higher in cirrhotic patients with HBV infection and alcoholism than those in patients with HBV infection or alcoholism alone. For patients with HBV infection and alcoholism, baseline serum HBV DNA (OR = 16.8, p = 0.025), antiviral nucleos(t)ides analogues (NUCs) therapy (OR = 0.01, p = 0.035), and serum α-fetoprotein (OR = 1.18, p = 0.045) were risk predictors of HCC by multivariate logistic regression models. The cumulative incidence of HCC was higher in patients with higher baseline serum HBV DNA. Antiviral NUCs therapy reduced the incidence of HCC.

Conclusions

Heavy alcohol consumption significantly increased the risk of HCC in HBV-related cirrhotic patients. Elevated baseline serum HBV DNA was a strong risk predictor of HCC and antiviral NUCs therapy reduced the incidence of HCC in cirrhotic patients with HBV infection and alcoholism.

Introduction

Hepatocellular carcinoma (HCC) is the fifth most commonly occurring cancer and the third most common cause of cancer-related death worldwide [1], [2], [3]. In Western countries, chronic alcohol use of greater than 80 g per day for more than 5 years increases the risk of HCC, and alcoholic cirrhosis is also a definite risk factor for HCC [4], [5], [6], [7]. Taiwan is a region of high prevalence of chronic hepatitis B (CHB) with increasing alcoholic liver disease [8], [9], [10]. Hepatitis B virus (HBV) infection has also been recognized as a major risk factor for cirrhosis and HCC [11], [12]. Serum HBV DNA level is a marker of viral replication and elevated serum HBV DNA level is a strong risk predictor of HCC in CHB patients [13], [14], [15], [16], [17]. Antiviral nucleos(t)ide analogues (NUCs) have been widely used to reduce the development of HCC in CHB patients with fibrosis or cirrhosis [18], [19], [20].

The synergism and interaction between HBV infection and alcohol consumption, in the pathogenesis of chronic liver disease and clinical outcomes, have been reported [4], [5], [6], [21]. However, the role of heavy alcohol consumption and HBV infection on the development of HCC remains uncertain and needs to be explored. We investigated the impact of heavy alcohol consumption and HBV infection on the development of HCC in cirrhotic patients.

Section snippets

Patients

We retrospectively reviewed 966 consecutive, documented cirrhotic patients (132 with heavy alcoholism and HBV infection, 632 with HBV infection, and 202 with heavy alcoholism) at the Cathay General Hospital, Taipei, North Taiwan, and E-DA Hospital/I-SHOU University, Kaohsiung, South Taiwan, between 2000 and 2009. We followed these patients until December 2011. All patients were followed-up for more than 6 months. The alcohol consumption behavior of each patient was routinely evaluated by

Baseline characteristics

The baseline characteristics of cirrhotic patients with concomitant HBV infection and alcoholism, HBV infection alone, and alcoholism alone are presented in Table 1. The rate was 13.7%, 65.4%, and 20.9% in cirrhotic patients with concomitant HBV infection and alcoholism, HBV infection alone, and alcoholism alone, respectively. The cirrhotic patients were found to be predominantly male. The mean age of patients with concomitant HBV infection and alcoholism was significantly younger than that in

Discussion

Our data showed that the 5-year cumulative incidence of HCC is 10.7% in alcoholic cirrhotic patients. Our data also showed that alcoholic cirrhotic patients with concomitant HBV infection have significantly higher incidence of HCC than those with HBV infection alone or alcoholism alone. The 5-year cumulative incidence of HCC was up to 36.8% in the patients with concomitant HBV infection and alcoholism. Our findings are consistent with earlier studies that found the synergism between severe

Financial support

This study is partial supported by EDAHP98032.

Conflict of interest

The authors who have taken part in this study declared that they do not have anything to disclose regarding funding or conflict of interest with respect to this manuscript.

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