Cigarette smoking, alcohol drinking, hepatitis B, and risk for hepatocellular carcinoma in Korea
Cigarette smoking, alcohol drinking, hepatitis B, and risk for hepatocellular carcinoma in Korea
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DOI：
10.1093/jnci/djh334
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发表时间：
2004-12-15
影响因子：
10.3
通讯作者：
Samet, JM
中科院分区：
文献类型：
--
作者：
Jee, SH;Ohrr, H;Samet, JM
背景：肝癌是世界范围内最常见的癌症之一，特别是在亚洲和非洲，那里的传染性肝炎和黄曲霉毒素暴露很常见。我们在韩国进行了一项关于肝癌的前瞻性队列研究，以评估吸烟、饮酒和乙肝对肝细胞癌死亡风险的独立影响和相互作用。方法：在1993年至2002年的随访期间，共有1283112名未患癌症的男性和女性中有3807人死于肝癌。所有参与者都报告了他们的吸烟和饮酒情况，其中47.2%的参与者记录了乙肝表面抗原(HBs)状态。根据年龄、饮酒、糖尿病和乙肝表面抗原状况调整比例风险模型，计算肝细胞癌死亡率的相对风险和95%可信区间(CI)。结果：男性吸烟与肝细胞癌死亡风险增加相关(RR=1.4；95%CI=1.3~1.6)，与女性无关(RR=1.1；CI=0.8~1.7)。男性乙肝表面抗原携带者死于肝细胞癌的相对危险度是阴性男性的24.3倍(95%CI=21.9~26.9)，女性为54.4倍(95%CI=24.8~119.5)。在接受乙肝表面抗原检测的男性亚组中，大量饮酒与肝细胞癌死亡风险相关(RR=1.5；95%CI=1.2~2.0)。在肝细胞癌死亡率方面，吸烟、饮酒和乙肝表面抗原之间没有交互作用。结论：吸烟、大量饮酒和乙肝表面抗原与肝细胞癌死亡风险增加独立相关，但没有协同作用。与男性相比，乙肝表面抗原阳性女性死于肝细胞癌的死亡率相对更高，这一点值得进一步研究。
Background: Liver cancer is one of the most common cancers worldwide, particularly in Asia and Africa, where infectious hepatitis and aflatoxin exposures are common. We conducted a prospective cohort study of liver cancer in Korea to assess the independent effects and interactions of smoking, alcohol consumption, and hepatitis B on risk of mortality from hepatocellular carcinoma. Methods: From a total of 1283 112 men and women free of cancer at baseline, 3807 died from liver cancer during follow-up from 1993 to 2002. All participants reported their smoking and alcohol consumption, and hepatitis B surface antigen (HBsAg) status was documented for 47.2% of the participants. Relative risk and 95% confidence intervals (CIs) of mortality from hepatocellular carcinoma were calculated using proportional hazards models adjusted for age, alcohol drinking, diabetes, and HBsAg status. Results: Current smoking was associated with increased risk of mortality from hepatocellular carcinoma in men (RR = 1.4; 95% CI = 1.3 to 1.6) but not women (RR = 1.1; CI = 0.8 to 1.7). The relative risk of mortality from hepatocellular carcinoma for male HBsAg carriers was 24.3 (95% CI = 21.9 to 26.9) times that in HBsAg-negative males; the relative risk for HBsAg-positive women was 54.4 (95% CI = 24.8 to 119.5). Heavy alcohol drinking was associated with hepatocellular carcinoma mortality risk in the subgroup of men who were tested for HBsAg (RR = 1.5; 95% CI = 1.2 to 2.0). There was no interaction among smoking, alcohol drinking, and HBsAg in terms of hepatocellular carcinoma mortality. Conclusion: Cigarette smoking, heavy alcohol consumption, and HBsAg were independently associated with increased risk of mortality from hepatocellular carcinoma but did not interact synergistically. The relatively higher increase in mortality from hepatocellular carcinoma in HBsAg-seropositive women compared with men merits further research.