Follow‐up study of hbs ag‐positive blood donors with special reference to effect of drinking and smoking on development of liver cancer

Abstract

In order to confirm the close association between chronic hepatitis B virus (HBV) infection and primary hepatocellular carcinoma (PHC) in Japan, 8,646 male hepatitis B surface antigen (HBs Ag)-positive blood donors (GPT less than or equal to 35 Karmen units) were followed up. Twenty liver cancer cases were observed during the follow-up period (average 6.2 years), the expected number calculated on the basis of age-specific incidence rates among the general population being 3.03. Therefore, the observed to expected ratio of liver cancer was 6.60, that is significantly higher than 1.0. During the same follow-up period, a total of 76 deaths were observed, of which 20 were due to liver cancers and 9 to liver cirrhoses, meaning that nearly 40% of deaths among the study subjects due to chronic liver diseases. Drinking and smoking habits in the liver cancer cases were compared with those observed in healthy male HBV carriers. A strong positive association between drinking habits and liver cancer was observed and there was a significant dose-response relationship after adjustment for cigarette smoking habits. A high risk of liver cancer was also observed among heavy smokers, but a significant dose-response relationship could not be found between smoking habits and liver cancer, partly because of the limited number of the study subjects. These findings suggest that HBV is a major etiologic agent of PHC in Japan where the HBs Ag prevalence rate is about 2%, and alcohol drinking and cigarette smoking may promote the process of HB viral hepato-carcinogenesis.

Cofactors associated with liver disease mortality in an HBsAg‐positive Mediterranean cohort: 20 years of follow‐up

“…In Japan, where HCC has been related mainly to HCV infection, an excess mortality due to HCC and LC in HBV carriers was also found. [10][11][12][13][14][15] In China and Taiwan, where HCC has been related mostly to HBV, the estimated risks for HCC among men vary between 7 and 103, [3][4][5][6][7][8][9] showing higher risks than those in other geographical areas. The higher risk of death from liver disease found in South East Asia has also been reported in Western studies.…”

“…[3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] Most of these studies have been carried out in Asian countries (4 in China, [3][4][5][6] 2 in Taiwan 7-9 and 6 in Japan [10][11][12][13][14][15] ); 4 in Western countries (2 in the US, 16,17 1 in the UK 18,19 and 1 in 20 )…”

“…Only 3 studies included women [17][18][19][20] and only 5 evaluated the role of other risk factors in mortality risk. [4][5][6]9,15,20 Estimates of the risk of death due to HCC in HBV carriers range from 5.6 to 103 times higher than that in hepatitis B surface antigen (HBsAg)-negative subjects. Reasons for the heterogeneity in these estimates are unclear.…”

“…Our comparison group was constituted by HBsAg-negative blood donors, and it leads to avoid, first, the bias known as ÔHealthy Donor EffectÕ and, second, the inclusion of HBV carriers. 13,15,19 These issues are not controlled in the studies in which general population is the comparison group. Third, we have carried out a nested case-control study to asses the role of other risk factors on the contribution to liver disease progression in Mediterranean HBsAg-positive subjects.…”

Alcohol consumption among patients with hepatitis B infection in northern Portugal considering gender and hepatitis B virus genotype differences

“…A longitudinal study of hepatitis B surface antigenepositive healthy blood donors tested in Japan between 1972 and 1975 found that alcohol consumption greater than 27 g/day (duration of alcohol use not stated) was associated with more than a fivefold increase in the relative risk for development of HCC (Oshima et al, 1984). A study that compared two case series suggested that patients with HCC caused by chronic HBV and chronic alcohol are approximately 10 years younger than patients with HCC caused by chronic HBV alone (Ohnishi et al, 1982;Pereira et al, 1994).…”