Risk factors for the rising rates of primary liver cancer in the United States
Risk factors for the rising rates of primary liver cancer in the United States
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DOI：
10.1001/archinte.160.21.3227
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发表时间：
2000-11-27
影响因子：
--
通讯作者：
Mason, AC
中科院分区：
文献类型：
--
作者：
El-Serag, HB;Mason, AC
背景：据报道，最近美国肝细胞癌的发病率有所增加。这种明显上升的原因尚不清楚。方法：我们检查了退伍军人事务部医疗中心患者治疗档案中与丙型肝炎、乙型肝炎和酒精性肝硬化相关的原发性肝癌的年龄特异性和年龄标准化住院率的时间变化。结果：1993 ~ 1998年间，本院共确诊原发性肝癌1605例。原发性肝癌的总体年龄调整比例住院率从1993年至1995年的每10万人36.4人（95%可信区间[CI]， 34.0-38.9）增加到1996年至1998年的每10万人47.5人（95%可信区间[CI]， 44.6-50.1）。与丙型肝炎病毒相关的原发性肝癌的年龄调整率增加了3倍，从1993年至1995年的每10万人2.3例（95% CI, 1.8-3.0）增加到1996年至1998年的每10万人7.0例（95% CI, 5.9-8.1）。与此同时，与丙型肝炎相关的原发性肝癌的年龄特异性发病率也向年轻患者转移。在同一时期，与乙型肝炎病毒（2.2 vs 3.1 / 100000）或酒精性肝硬化（8.4 vs 9.1 / 100000）相关的原发性肝癌的年龄调整率保持稳定。无危险因素的原发性肝癌发病率也没有统计学上的显著变化，从1993年至1995年的17.5例（95% CI, 15.8-19.1）到1996年至1998年的19.0例（95% CI, 17.3-20.7）。结论：丙型肝炎病毒感染是美国退伍军人原发性肝癌病例增加的主要原因。与酒精性肝硬化和乙型肝炎病毒感染相关的原发性肝癌发病率保持稳定。
Background: A recent increase in the incidence of hepatocellular carcinoma was reported in the United States. The cause of this witnessed rise remains unknown.Methods: We examined the temporal changes in both age-specific and age-standardized hospitalization rates of primary liver cancer associated with hepatitis C, hepatitis B, and alcoholic cirrhosis in the Department of Veterans Affairs Medical Center's Patient Treatment File.Results: A total of 1605 patients were diagnosed with primary liver cancer between 1993 and 1998. The over all age-adjusted proportional hospitalization rate for primary liver cancer increased from 36.4 per 100 000 (95% confidence interval [CI], 34.0-38.9) between 1993 and 1995 to 47.5 per 100 000 (95% CI, 44.6-50.1) between 1996 and 1998. There was a 3-fold increase in the age-adjusted rates for primary liver cancer associated with hepatitis C virus, from 2.3 per 100 000 (95%, CI, 1.8-3.0) between 1993 and 1995 to 7.0 per 100 000 (95% CI, 5.9-8.1) between 1996 and 1998. Concomitant with this rise, the age-specific rates for primary liver cancer associated with hepatitis C also shifted toward younger patients. During the same periods, the age-adjusted rates for primary liver cancer associated with either hepatitis B virus (2.2 vs 3.1 per 100 000) or alcoholic cirrhosis (8.4 vs 9.1 per 100 000) remained stable. The rates for primary liver cancer without risk factors also remained without a statistically significant change, from 17.5 (95% CI, 15.8-19.1) between 1993 and 1995 to 19.0 per 100 000 (95% CI, 17.3-20.7) between 1996 and 1998.Conclusions: Hepatitis C virus infection accounts for most of the increase in the number of cases of primary liver cancer among US veterans. The rates of primary liver cancer associated with alcoholic cirrhosis and hepatitis B virus infection have remained stable.