Division of Gastroenterology and Hepatology, Department of Medicine, E-DA Hospital/I-Shou University, Kaohsiung; Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung.
BACKGROUND & AIMS:
Taiwan has a high prevalence of hepatitis B viral(HBV)infection and hepatocellular carcinoma (HCC) with increasing consumption of alcohol. We investigated the impact of heavy alcohol consumption and HBV infection on HCC in cirrhotic patients.
966 cirrhotic patients (132 patients with HBV infection and alcoholism, 632 patients with HBV infection, and 202 patients with alcoholism) between 2000 and 2009 were enrolled and followed until 2011. The primary end-point was newly developed HCC.
Within the three patient groups respectively-cirrhotic patients with HBV infection and alcoholism, HBV infection, and alcoholism-38 (28.8%), 100 (15.8%), and 21 (10.4%) showed newly developed HCC. The 10-year cumulative incidence (52.8% vs. 39.8% vs. 25.6%, P<0.001) and annual incidence (9.9%, 4.1%, and 2.1%) of HCC were significantly higher in cirrhotic patients with HBV infection and alcoholism than those with HBV infection or those with alcoholism. For patients with HBV infection and alcoholism, baseline serum HBV DNA (OR = 16.8, P=0.025), antiviral nucleos(t)ides analogues (NUCs) therapy (OR=0.01, P=0.035), and serum α-fetoprotein (OR=1.18, P=0.045) were risk predictors for HCC by multivariate logistic regression models. The cumulative incidence of HCC was higher in patients with higher baseline serum HBV DNA. Antiviral NUCs therapy reduced the incidence of HCC.
Heavy alcohol consumption significantly increased the risk of HCC in HBV-related cirrhotic patients. Elevated baseline serum HBV DNA was a strong risk predictor of HCC and antiviral NUCs therapy reduced the incidence of HCC in cirrhotic patients with HBV infection and alcoholism.