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