Hepatitis C Virus Infection and the Temporal Trends in the Risk of Liver Cancer: A National Register-Based Cohort Study in Sweden

Abstract

◥Background: In many countries, including Sweden, the birth cohorts with the highest prevalence of hepatitis C virus (HCV) infection have now reached the ages with high risk of primary liver cancer (PLC). The aims of this study were to investigate the temporal trends in PLC incidence and the relative risks of PLC among people diagnosed with HCV infection between 1990 and 2015.Methods: The HCV cohort (n ¼ 52,853) was compared with a matched non-HCV comparison cohort (n ¼ 523,649). Both the national Cancer Register (CR) and Cause of Death Register (DR) were used for follow-up. The crude and age-standardized PLC incidence rates were calculated. The relative risk was estimated as standardized incidence ratios (SIR) and as HRs using stratified Cox hazards regression.Results: There were 1,609 with PLC diagnosis in the HCV cohort; the annual number increased continuously with the crude incidence rate reaching 4.56 per 1,000 person-years in 2013 while remaining low and stable in the comparison cohort. In the HCV cohort, the age-standardized PLC incidence rates per 1,000 person-years remained relatively constant at 2.64 [95% confidence interval (CI), 1.54-3.75] in 2000 and 3.31 (2.51-4.12) in 2014. The highest SIR was 73 (65.9-79.5) among those infected for 35 to 40 years; and the highest HR was 65.9 (55.9-77.6) for men and 62.2 (31.9-121.1) for women.Conclusions: There was a considerable increase in PLC incidence over time and an extremely high relative risk in the population with HCV infection for more than 35 years.Impact: The national HCV-associated PLC incidence should be monitored in future studies to evaluate the effect of directacting antiviral (DAA) treatment.

Long‐term incidence in hepatocellular carcinoma and intrahepatic bile duct cancer in Denmark, Finland, Norway and Sweden, role of Thorotrast?

“…Diagnostics of HCV have been possible only since 1989, and the first SE prevalence estimates HCV infection gave a population prevalence of about 0.5% at the beginning of the 1990s 39 . Infections and HCC in infected persons have increased with time but there is no indication that HCV infection would have been prevalent at the time before 1989 40 . In DK chronic hepatitis C infection was found in 0.2% of the adult population with a decreasing trend 41 …”

“…39 Infections and HCC in infected persons have increased with time but there is no indication that HCV infection would have been prevalent at the time before 1989. 40 In DK chronic hepatitis C infection was found in 0.2% of the adult population with a decreasing trend. 41 The study has limitations, first, it is ecological and all inferences about underlying causes are indirect.…”

Risk of extrahepatic cancer in a nationwide cohort of hepatitis C virus infected persons treated with direct‐acting antivirals

“…The remaining HCV‐cohort comprised 53 002 individuals. The reported routes of transmission were unknown/missing in 50%, injection drug use in 40%, transfusion of blood/blood products before 1992 in 5% 30 . From 1992 injection drug use is the assumed route of transmission in the majority of new infections 25…”

“…The reported routes of transmission were unknown/missing in 50%, injection drug use in 40%, transfusion of blood/blood products before 1992 in 5%. 30 From 1992 injection drug use is the assumed route of transmission in the majority of new infections. 25 An individually matched comparison-cohort without HCV diagnosis from the general population was obtained from SCB.…”

Clinical application of thioredoxin reductase as a novel biomarker in liver cancer

“…However, a main cause of PLC is viral hepatitis, which accounts for a large percentage of cases in China 16,17 . Approximately 85% of cirrhosis and liver cancer patients are diagnosed with viral hepatitis, which indicates that viral hepatitis constitutes a significant risk factor for liver cancer 18,19 .…”