The Gambia Liver Cancer Study: Infection with hepatitis B and C and the risk of hepatocellular carcinoma in West Africa
The Gambia Liver Cancer Study: Infection with hepatitis B and C and the risk of hepatocellular carcinoma in West Africa
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DOI：
10.1002/hep.20027
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发表时间：
2004-01-01
期刊：
影响因子：
13.5
通讯作者：
Montesano, R
中科院分区：
文献类型：
--
作者：
Kirk, GD;Lesi, OA;Montesano, R
肝细胞癌（HCC）是冈比亚最常见的癌症。B型肝炎病毒（HBV）感染是地方性的，15%至20%的人口是慢性携带者，而丙型肝炎病毒（HCV）的流行率较低。我们从三个地点招募了216例HCC事件病例和408例对照。61%（129/211）的HCC患者和16%（64/402）的对照组中存在HBV携带，而19%（36/191）的HCC患者和3%（11/382）的对照组中存在HCV血清阳性。与HBV感染者相比，HCV感染的HCC患者年龄明显更大，更可能是女性。HCC风险增加与慢性HBV（比值比，16.7; 95% CI，9.7-28.7）、HCV（16.7; 6.9-40.1）和双重感染（35.3; 3.9-323）密切相关。我们解释的叠加性质的风险与合并感染的代表HBV和HCV的行为主要通过共享的步骤，在多阶段的肝癌发生过程。在年轻的参与者中没有观察到HCV感染，这表明可能存在队列效应。与HCV相比，HBV相关的HCC患者的年龄和性别差异的原因尚不清楚，但传播模式和暴露年龄可能是影响因素。总之，在对冈比亚的研究参与者进行的标准化评估中，大多数HCC病例可归因于HBV（57%），但HCV增加了一个显著的比例（20%），特别是在老年患者和女性中。如果丙型肝炎病毒传播在未来的队列中没有持续下去，将现有资源集中在乙肝疫苗接种工作上可以大大改善撒哈拉以南非洲癌症死亡的主要原因。
Hepatocellular carcinoma (HCC) is the most common cancer in The Gambia. Hepatitis B virus (HBV) infection is endemic, with 15% to 20% of the population being chronic carriers, whereas hepatitis C virus (HCV) prevalence is low. We recruited 216 incident cases of HCC and 408 controls from three sites. HBV carriage was present in 61% (129/211) of HCC patients and 16% (64/402) of controls, whereas 19% (36/191) of HCC patients were HCV seropositive compared with 3% (11/382) of controls. HCC patients with HCV were notably older and were more likely to be female than those with HBV. Increased HCC risk was strongly associated with chronic HBV (odds ratio, 16.7; 95% Cl, 9.7-28.7), HCV (16.7; 6.9-40.1), and dual infection (35.3; 3.9-323). We interpret the additive nature of risk with coinfection as representative of HBV and HCV acting primarily through shared steps in the multistage process of hepatocarcinogenesis. HCV infection was not observed among younger participants, suggesting a possible cohort effect. Reasons for the striking age and gender differences in HCC associated with HBV compared with HCV are unclear, but transmission patterns and age at exposure may be factors. In conclusion, in a standardized evaluation of well-characterized study participants from The Gambia, most cases of HCC are attributable to HBV (57%), but HCV adds a significant fraction (20%), especially among older patients and females. If HCV transmission is not perpetuated in future cohorts, focusing available resources on HB vaccination efforts could greatly ameliorate a major cause of cancer death in sub-Saharan Africa.