Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD.
Int J Cancer. 2019 Feb 1;144(3):431-439. doi: 10.1002/ijc.31643. Epub 2018 Nov 28.
Hepatitis B virus (HBV) infection causes hepatocellular carcinoma (HCC). Associations with other cancers are not established. We systematically assessed associations between HBV infection and cancers in the US elderly population. We conducted a case-control study using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database in US adults aged ≥66 years. Cases (N = 1,825,316) were people with first cancers diagnosed in SEER registries (1993-2013). Controls (N = 200,000) were randomly selected, cancer-free individuals who were frequency-matched to cases on age, sex, race and calendar year. Associations with HBV infection (ascertained by Medicare claims) were assessed by logistic regression. HBV prevalence was higher in cases than controls (0.6% vs. 0.5%). HBV was positively associated with cancers of the stomach (adjusted odds ratio [aOR] = 1.19; 95% confidence intervals [CI] = 1.03-1.37), anus (1.66; 1.17-2.33), liver (10.6; 9.66-11.6), intrahepatic bile ducts (1.67; 1.18-2.37), nasopharynx (2.08; 1.33-3.25), as well as myelodysplastic syndrome (1.26; 1.07-1.49) and diffuse large B-cell lymphoma (DLBCL) (1.24; 1.06-1.46). Inverse associations were observed with female breast (aOR = 0.86; 95%CI = 0.76-0.98) and prostate (0.81; 0.73-0.91) cancers and chronic lymphocytic leukemia (0.77; 0.62-0.96). Associations were maintained in sensitivity analyses conducted in people without claims for cirrhosis or hepatitis C or human immunodeficiency virus infections. HBV infection is associated with increased risk of cancers other than HCC, such as bile duct cancers and DLBCL. The biological mechanisms by which HBV may lead to these cancers need to be explored.
乙型肝炎病毒（HBV）感染可导致肝细胞癌（HCC）。其与其他癌症的关联尚未确定。我们系统地评估了 HBV 感染与美国老年人群癌症之间的关系。我们在美国年龄≥66 岁的成年人中使用监测、流行病学和最终结果（SEER）-医疗保险数据库进行了病例对照研究。病例（N=1825316）为 SEER 登记处首次诊断出的癌症患者（1993-2013 年）。对照（N=200000）为随机选择的、无癌症的个体，与病例按年龄、性别、种族和日历年份进行频数匹配。通过逻辑回归评估 HBV 感染（通过医疗保险索赔确定）与癌症的关联。病例中 HBV 的患病率高于对照组（0.6%比 0.5%）。HBV 与胃癌（调整后的优势比[aOR] = 1.19；95%置信区间[CI] = 1.03-1.37）、肛门癌（1.66；1.17-2.33）、肝癌（10.6；9.66-11.6）、肝内胆管癌（1.67；1.18-2.37）、鼻咽癌（2.08；1.33-3.25）以及骨髓增生异常综合征（1.26；1.07-1.49）和弥漫性大 B 细胞淋巴瘤（DLBCL）（1.24；1.06-1.46）呈正相关。而与女性乳腺癌（aOR=0.86；95%CI=0.76-0.98）和前列腺癌（0.81；0.73-0.91）以及慢性淋巴细胞白血病（0.77；0.62-0.96）呈负相关。在没有肝硬化、丙型肝炎或人类免疫缺陷病毒感染索赔的人群中进行的敏感性分析中，相关性仍然存在。HBV 感染与 HCC 以外的癌症风险增加有关，如胆管癌和 DLBCL。需要探索 HBV 导致这些癌症的生物学机制。
