Association of Metabolic Risk Factors With Risks of Cancer and All‐Cause Mortality in Patients With Chronic Hepatitis B

Abstract

Background and Aims Long‐term antiviral therapy can effectively suppress viral replication and improve clinical outcomes in patients with chronic hepatitis B (CHB), but it cannot eliminate risk of HCC. We investigated the association of metabolic risk factors with the risks of cancer and all‐cause mortality in patients with CHB. Approach and Results This nationwide population‐based study from the Korean National Health Insurance Service database consisted of adults with CHB who underwent health examinations from 2007 through 2012. We collected baseline data on metabolic risk factors, including obesity, high blood pressure, hypercholesterolemia, and diabetes. The risks of developing HCC, non‐HCC cancer, and overall death were analyzed according to the metabolic risk profile. The study population composed of 317,856 patients (median age, 46 years [interquartile range, 37‐54 years]; 219,418 men [69.0%]) had 2,609,523.8 person‐years of follow‐up. A total of 18,850 HCCs, 22,164 non‐HCC cancers, and 15,768 deaths were observed during a median follow‐up period of 8.5 years. The metabolic risk factor burden was positively associated with the risks of HCC, non‐HCC cancer, and all‐cause mortality (all P < 0.0001 for trend). Patients with ≥3 metabolic risk factors, compared with those without metabolic risk factors, showed adjusted hazard ratios of 1.23 (95% CI, 1.16‐1.31) for HCC, 1.34 (95% CI, 1.27‐1.41) for non‐HCC cancer, and 1.31 (95% CI, 1.23‐1.39) for all‐cause mortality. Among patients receiving antiviral therapy for over 5 years, the risk‐increasing association of the sum of metabolic risk factors with the risks of HCC and overall death was consistent. Conclusion The metabolic risk factor burden was associated with increased risks of HCC, non‐HCC cancer, and all‐cause mortality in patients with CHB.

Influence of Metabolic Syndrome on Cancer Risk in HBV Carriers: A Nationwide Population Based Study Using the National Health Insurance Service Database

“…Recently, a study on the association of metabolic risk factors with risks of cancer and all-cause mortality in patients with chronic hepatitis B was published using a similar but different dataset from the NHIS database. In the study by Lee et al [17], the risk of developing HCC and non-HCC cancers both increased in patients with MS, which was different from the result of our study that showed negative association of HCC with the presence of MS. There could be several reasons for this discrepancy.…”

“…Therefore, assessment of individual MS components may help future therapies target the important factors of MS that contribute most to the development of malignancies. In the current study, MS tended to increase nearly all cancer risks in individuals with HBV infection, similar to the trend seen in the general population between MS and cancer more generally [16,17]. A higher number of MS components was associated with a significantly increased risk of all cancers types.…”

Editorial: central obesity is a risk factor for hepatocellular carcinoma in Asian patients with chronic hepatitis B on anti‐viral therapy

“…However, the risk of HCC is not eliminated even after complete viral suppression on treatment 1,2 . Coexisting metabolic risk factors, such as diabetes, hypertension, obesity and dyslipidaemia, have been reported to be associated with higher HCC risk in CHB patients 3,4 . Because there is population ageing and CHB patients are living longer, the prevalence of coexisting metabolic risk factors is expected to rise 5 …”

Association of central obesity with hepatocellular carcinoma in patients with chronic hepatitis B receiving antiviral therapy

“…Current antiviral drugs cannot totally eliminate HCC, even in those patients who achieve complete viral response. Previous studies had reported that metabolic syndrome, characterised by obesity, hepatic steatosis, hypertension, diabetes mellites, and dyslipidaemia, was related to the increased risk of HCC 1,2 . However, the effect of certain specific metabolic factor on HCC development is still controversial.…”