Chen Jian-guo, Lu Jian-hua, Zhu Yuan-rong, Zhu Jian, Zhang Yong-hui
Qidong Liver Cancer Institute, Qidong 226200, China.
Zhonghua Liu Xing Bing Xue Za Zhi. 2010 Jul;31(7):721-6.
To study the relationship between hepatitis B virus (HBV) and primary liver cancer (PLC), and to assess the outcome of PLC in the carriers of HBsAg.
General population over age of 15 from a community in Qidong was screened for HBsAg, anti-HBs, and alanine transaminase (ALT) in 1976, and followed-up thenceforth. From January 1, 1977 through December 31, 2007, 12 351 people were enrolled in the cohort, and their occurrence, outcome of PLC and other cancers, together with all the withdrawals due to death were linked to and checked with database from Qidong Cancer Registry and Qidong Vital Registry programs.
The total observed person-years (PYs) were 355 305.0. One hundred and seventy-three PLC cases were identified among the HBsAg carriers, with an incidence of 361.55 per 100 000 PYs, while PLC cases were only 95 for the non-carriers, with an incidence of 30.90 per 100 000 PYs. The overall relative risk (RR) was 11.70 (95%CI: 9.06 - 15.19), with RR 12.30 for men and 10.46 for women. HBsAg carriers had high incidence at each age group, compared with the non-carriers for both men and women. Data from cross-over analysis showed that the incidence rates of PLC for the sub-cohorts of female non-carriers, male non-carriers, female carriers, and male carriers were 1.00, 3.07, 10.46, and 37.76, respectively. The cumulative rates of PLC in the 4 groups were 0.86%, 2.73%, 10.22%, and 34.19%, respectively. Results from non-conditional logistic regression model showed that the gender (male), age, HBsAg(+), and ALT(+) were risk factors for the development of PLC while anti-HBs(+) demonstrated a protective effect. No relationship was found among carriers and non-carriers for cancer sites such as lung, stomach, esophagus, intestine, pancreas, breast, cervix, bladder, and lymphoma, brain tumor, or leukemia.
Causation and its strength, together with specificity and persistency of the association were confirmed from this HBsAg-related cohort study in the general population in Qidong. Intervention measures on HBV should be highlighted for the control of PLC among the HBV infected individuals.
研究乙型肝炎病毒（HBV）与原发性肝癌（PLC）之间的关系，并评估HBsAg携带者中PLC的发病情况。
1976年对启东某社区15岁以上的普通人群进行HBsAg、抗-HBs和丙氨酸转氨酶（ALT）筛查，随后进行随访。从1977年1月1日至2007年12月31日，该队列共纳入12351人，他们的PLC及其他癌症的发生、结局，以及所有因死亡导致的退出情况均与启东癌症登记处和启东生命登记处项目的数据库进行关联和核对。
总观察人年数（PYs）为355305.0。HBsAg携带者中确诊PLC病例173例，发病率为每100000人年361.55例，而非携带者中PLC病例仅95例，发病率为每100000人年30.90例。总体相对危险度（RR）为11.70（95%CI：9.06 - 15.19），男性RR为12.30，女性为10.46。HBsAg携带者在各年龄组的发病率均高于非携带者，男女皆是。交叉分析数据显示，女性非携带者、男性非携带者、女性携带者和男性携带者亚组的PLC发病率分别为1.00、3.07、10.46和37.76。4组的PLC累积发病率分别为0.86%、2.73%、10.22%和34.19%。非条件logistic回归模型结果显示，性别（男性）、年龄、HBsAg(+)和ALT(+)是PLC发生的危险因素，而抗-HBs(+)具有保护作用。在肺癌、胃癌、食管癌、肠癌、胰腺癌、乳腺癌、宫颈癌、膀胱癌、淋巴瘤、脑肿瘤或白血病等癌症部位，携带者和非携带者之间未发现关联。
启东普通人群中这项与HBsAg相关的队列研究证实了HBV与PLC之间关联的因果关系、强度、特异性和持续性。对于HBV感染者中PLC的防控，应着重采取针对HBV的干预措施。
