Krishnamurthy Padmini, Hazratjee Nyla, Opris Dan, Agrawal Sangeeta, Markert Ronald
Wright State University, Ohio Veterans Affairs Medical Center, Dayton, Ohio, USA.
J Gastrointest Oncol. 2016 Jun;7(3):426-32. doi: 10.21037/jgo.2016.01.09.
Approximately 15% to 35% of those with chronic hepatitis C (CHC) related cirrhosis will develop hepatocellular cancer (HCC). With this burden increasing across the globe, identification of risk factors for HCC has become imperative. Exposure to Agent Orange has been implicated as a possible risk factor for liver cancer in a study from the Republic of Korea. However, there has been no study in U.S. veterans with CHC and cirrhosis that has evaluated exposure to Agent Orange as a risk factor for HCC. We conducted a retrospective study of U.S. military veterans diagnosed with CHC and cirrhosis over a period of 14 years to evaluate potential risk factors for HCC including exposure to Agent Orange.
We retrospectively reviewed 390 patients with confirmed CHC-related cirrhosis between 2000 and 2013 and identified patients with HCC. We compared demographic, laboratory, and other clinical characteristics of patients with and without HCC.
The mean age of the cohort was 51 years (SD =7.5), with the majority being male (98.5%). Seventy-nine of 390 (20.2%) patients developed HCC, diagnosed on average 8 (SD =4.8) years after diagnosis of CHC. Nearly half (49.4%) were Childs A, 40.5% were Childs B, and 10.1% were Childs C. HCC patients were more likely to be African American than non-HCC patients (40.5% vs. 25.4%, P=0.009) and to be addicted to alcohol (86.1% vs. 74.3%, P=0.027). A trend toward significance was seen in the HCC group for exposure to Agent Orange (16.5% vs. 10.0%, P=0.10) and smoking addiction (88.6% vs. 80.7%, P=0.10). Consequently, race, alcohol addiction, Agent Orange exposure, and smoking addiction were included in the multivariable logistic regression (MLR) analysis. Alcohol addiction [odds ratio (OR) =2.17; 95% confidence interval (CI), 1.07-4.43] and African American race (OR =2.07; 95% CI, 1.22-3.51) were found to be the only two definitive independent risk factors for HCC in our sample.
African American race and alcohol addiction were independent risk factors for HCC development in this U.S. veteran population. There was no significant association between exposure to Agent Orange and HCC, although larger studies are needed in the U.S. military veteran population to evaluate further this toxic herbicide from the Vietnam War era.
约15%至35%的慢性丙型肝炎（CHC）相关肝硬化患者会发展为肝细胞癌（HCC）。随着全球范围内这一负担的增加，识别HCC的风险因素变得至关重要。在韩国的一项研究中，接触橙剂被认为是肝癌的一个可能风险因素。然而，在美国患有CHC和肝硬化的退伍军人中，尚未有研究评估接触橙剂作为HCC的风险因素。我们对14年间被诊断为CHC和肝硬化的美国退伍军人进行了一项回顾性研究，以评估包括接触橙剂在内的HCC潜在风险因素。
我们回顾性分析了2000年至2013年间390例确诊为CHC相关肝硬化的患者，并确定了HCC患者。我们比较了有和没有HCC患者的人口统计学、实验室和其他临床特征。
该队列的平均年龄为51岁（标准差=7.5），大多数为男性（98.5%）。390例患者中有79例（20.2%）发生了HCC，平均在CHC诊断后8年（标准差=4.8）被诊断出。近一半（49.4%）为Childs A级，40.5%为Childs B级，10.1%为Childs C级。HCC患者比非HCC患者更可能是非裔美国人（40.5%对25.4%，P=0.009）且有酒精成瘾（86.1%对74.3%，P=0.027）。在HCC组中，接触橙剂（16.5%对10.0%，P=0.10）和吸烟成瘾（88.6%对80.7%，P=0.10）有显著趋势。因此，种族、酒精成瘾、接触橙剂和吸烟成瘾被纳入多变量逻辑回归（MLR）分析。酒精成瘾[比值比（OR）=2.17；95%置信区间（CI），1.07 - 4.43]和非裔美国人种族（OR =2.07；95%CI，1.22 - 3.51）是我们样本中HCC仅有的两个明确的独立风险因素。
在这个美国退伍军人人群中，非裔美国人种族和酒精成瘾是HCC发生的独立风险因素。接触橙剂与HCC之间没有显著关联，尽管在美国退伍军人人群中需要进行更大规模的研究，以进一步评估这种越战时期的有毒除草剂。
