Cicalese Luca, Raun Loren, Shirafkan Ali, Campos Laura, Zorzi Daria, Montalbano Mauro, Rhoads Colin, Gazis Valia, Ensor Katherine, Rastellini Cristiana
Department of Surgery, University of Texas Medical Branch, Galveston, Texas, USA.
Department of Statistics, Rice University, Houston, Texas, USA.
Liver Cancer. 2017 Nov;6(4):287-296. doi: 10.1159/000475776. Epub 2017 Aug 29.
Primary liver cancer is a significant cause of cancer-related death in both the United States and the world at large. Hepatocellular carcinoma comprises 90% of these primary liver cancers and has numerous known etiologies. Evaluation of these identified etiologies and other traditional risk factors cannot explain the high incidence rates of hepatocellular carcinoma in Texas. Texas is home to the second largest petrochemical industry and agricultural industry in the nation; industrial activity and exposure to pathogenic chemicals have never been assessed as potential links to the state's increased incidence rate of hepatocellular carcinoma.
The association between the county-level concentrations of 4 air pollutants known to be linked to liver cancer, vinyl chloride, arsenic, benzene, and 1,3-butadiene, and hepatocellular carcinoma rates was evaluated using nonparametric generalized additive logistic regression and gamma regression models. Hepatocellular carcinoma incidence rates for 2000-2013 were evaluated in comparison to 1996 and 1999 pollution concentrations and hepatocellular carcinoma rates for the subset of 2006-2013 were evaluated in comparison to 2002 and 2005 pollution concentrations, respectively.
The analysis indicates that the relationship between the incidence of liver cancer and air pollution and risk factors is nonlinear. There is a consistent significant positive association between the incidence of liver cancer and hepatitis C prevalence rates (gamma all years, < 0.05) and vinyl chloride concentrations (logistic 2002 and 2005, < 0.0001; gamma 2002 and 2005, < 0.05).
This study suggests that vinyl chloride is a significant contributor to the incidence of liver cancer in Texas. The relationship is notably nonlinear. Further, the study supports the association between incidence of liver cancer and prevalence of hepatitis B.
原发性肝癌是美国乃至全球癌症相关死亡的一个重要原因。肝细胞癌占这些原发性肝癌的90%，并且有许多已知病因。对这些已确定病因及其他传统风险因素的评估无法解释德克萨斯州肝细胞癌的高发病率。德克萨斯州是美国第二大石化产业和农业产业所在地；工业活动以及接触致病化学物质从未被评估为该州肝细胞癌发病率增加的潜在关联因素。
使用非参数广义相加逻辑回归和伽马回归模型评估已知与肝癌相关的4种空气污染物（氯乙烯、砷、苯和1,3 - 丁二烯）的县级浓度与肝细胞癌发病率之间的关联。分别将2000 - 2013年的肝细胞癌发病率与1996年和1999年的污染浓度进行比较评估，以及将2006 - 2013年子集的肝细胞癌发病率与2002年和2005年的污染浓度进行比较评估。
分析表明肝癌发病率与空气污染及风险因素之间的关系是非线性的。肝癌发病率与丙型肝炎患病率（所有年份伽马值，<0.05）以及氯乙烯浓度（2002年和2005年逻辑回归值，<0.0001；2002年和2005年伽马值，<0.05）之间存在一致的显著正相关。
本研究表明氯乙烯是德克萨斯州肝癌发病率的一个重要促成因素。这种关系明显是非线性的。此外，该研究支持肝癌发病率与乙型肝炎患病率之间的关联。
