美国肝细胞癌风险因素的人群归因分数。
Population-attributable fractions of risk factors for hepatocellular carcinoma in the United States.
机构信息
Johann Wolfgang Goethe University Hospital, Frankfurt am Main, Germany.
出版信息
Am J Gastroenterol. 2013 Aug;108(8):1314-21. doi: 10.1038/ajg.2013.160. Epub 2013 Jun 11.
OBJECTIVES
Risk factors for hepatocellular carcinoma (HCC) include hepatitis B and C viruses (HBV, HCV), excessive alcohol consumption, rare genetic disorders and diabetes/obesity. The population attributable fractions (PAF) of these factors, however, have not been investigated in population-based studies in the United States.
METHODS
Persons ≥68 years diagnosed with HCC (n=6,991) between 1994 and 2007 were identified in the SEER-Medicare database. A 5% random sample (n=255,702) of persons residing in SEER locations were selected for comparison. For each risk factor, odds ratios (ORs), 95% confidence intervals (95% CI) and PAFs were calculated.
RESULTS
As anticipated, the risk of HCC was increased in relationship to each factor: HCV (OR 39.89, 95% CI: 36.29-43.84), HBV (OR 11.17, 95% CI: 9.18-13.59), alcohol-related disorders (OR 4.06, 95% CI: 3.82-4.32), rare metabolic disorders (OR 3.45, 95% CI: 2.97-4.02), and diabetes and/or obesity (OR 2.47, 95% CI: 2.34-2.61). The PAF of all factors combined was 64.5% (males 65.6%; females 62.2%). The PAF was highest among Asians (70.1%) and lowest among black persons (52.4%). Among individual factors, diabetes/obesity had the greatest PAF (36.6%), followed by alcohol-related disorders (23.5%), HCV (22.4%), HBV (6.3%) and rare genetic disorders (3.2%). While diabetes/obesity had the greatest PAF among both males (36.4%) and females (36.7%), alcohol-related disorders had the second greatest PAF among males (27.8%) and HCV the second greatest among females (28.1%). Diabetes/obesity had the greatest PAF among whites (38.9%) and Hispanics (38.1%), while HCV had the greatest PAF among Asians (35.4%) and blacks (34.9%). The second greatest PAF was alcohol-related disorders in whites (25.6%), Hispanics (30.1%) and blacks (and 18.5%) and HBV in Asians (28.5%).
CONCLUSIONS
The dominant risk factors for HCC in the United States among persons ≥68 years differ by sex and race/ethnicity. Overall, eliminating diabetes/obesity could reduce the incidence of HCC more than the elimination of any other factor.
目的
肝细胞癌（HCC）的危险因素包括乙型肝炎和丙型肝炎病毒（HBV、HCV）、过量饮酒、罕见的遗传疾病和糖尿病/肥胖症。然而，在美国基于人群的研究中，这些因素的人群归因分数（PAF）尚未得到调查。
方法
在 SEER-Medicare 数据库中确定了 1994 年至 2007 年间诊断为 HCC（n=6991）的≥68 岁的患者。选择 SEER 地点居住的人群的 5%随机样本（n=255702）进行比较。对于每个危险因素，计算比值比（OR）、95%置信区间（95%CI）和 PAF。
结果
正如预期的那样，每种因素的 HCC 风险都增加：HCV（OR 39.89，95%CI：36.29-43.84）、HBV（OR 11.17，95%CI：9.18-13.59）、酒精相关疾病（OR 4.06，95%CI：3.82-4.32）、罕见代谢疾病（OR 3.45，95%CI：2.97-4.02）和糖尿病和/或肥胖症（OR 2.47，95%CI：2.34-2.61）。所有因素综合的 PAF 为 64.5%（男性 65.6%；女性 62.2%）。亚洲人的 PAF 最高（70.1%），黑人的 PAF 最低（52.4%）。在个别因素中，糖尿病/肥胖症的 PAF 最高（36.6%），其次是酒精相关疾病（23.5%）、HCV（22.4%）、HBV（6.3%）和罕见遗传疾病（3.2%）。虽然糖尿病/肥胖症在男性（36.4%）和女性（36.7%）中的 PAF 最高，但酒精相关疾病在男性中的 PAF 排名第二（27.8%），而 HCV 在女性中的 PAF 排名第二（28.1%）。糖尿病/肥胖症在白人（38.9%）和西班牙裔（38.1%）中的 PAF 最高，而 HCV 在亚洲人（35.4%）和黑人（34.9%）中的 PAF 最高。第二大 PAF 是白人（25.6%）、西班牙裔（30.1%）和黑人（和 18.5%）中的酒精相关疾病以及亚洲人的 HBV（28.5%）。
结论
≥68 岁人群中，美国 HCC 的主要危险因素因性别和种族/民族而异。总体而言，消除糖尿病/肥胖症可能比消除任何其他因素更能降低 HCC 的发病率。
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