Division of Cancer Control and Population Sciences, UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, Pennsylvania.
Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.
Cancer Epidemiol Biomarkers Prev. 2021 Feb;30(2):380-387. doi: 10.1158/1055-9965.EPI-20-1201. Epub 2020 Nov 13.
While the associations between individual lifestyle factors and risk of hepatocellular carcinoma (HCC) have been described previously, their combined impact on HCC risk is unknown.
The association of a composite score of healthy lifestyle factors, including body mass index, alcohol consumption, cigarette smoking, alternative Mediterranean diet, and sleep duration, and HCC risk was examined in the Singapore Chinese Health Study, an ongoing prospective cohort study of 63,257 Chinese men and women. Cox proportional hazard regression method was used to estimate HR and its 95% confidence interval (CI). Conditional logistic regression method was used to evaluate this composite lifestyle score-HCC risk association among a subset of individuals who tested negative for hepatitis B surface antigen (HBsAg) and anti-hepatitis C antibody.
After a mean follow-up of 17.7 years, 561 participants developed HCC. Individuals with higher composite scores representing healthier lifestyles (range 0-8) were at significantly lower risk of HCC. Compared with the lowest composite score category (0-4), the HRs (95% CIs) for the composite scores of 5, 6, 7, and 8 were 0.67 (0.62-0.85), 0.61 (0.48-0.77), 0.49 (0.37-0.65), and 0.13 (0.06-0.30), respectively ( < 0.0001). A similar inverse association was observed in participants with negative HBsAg and anti-hepatitis C virus (HCV)-negative serology (HR, 0.38; 95% CI, 0.19-0.79; for the highest vs. the lowest category of the composite scores; = 0.001).
Healthy lifestyles protect against HCC development, especially for individuals without hepatitis B virus and HCV infections.
This study highlights the importance of a comprehensive lifestyle modification strategy for HCC primary prevention.
虽然个体生活方式因素与肝细胞癌（HCC）风险之间的关联此前已有描述，但它们对 HCC 风险的综合影响尚不清楚。
本研究在一项正在进行的、针对 63257 名中国男性和女性的前瞻性队列研究——新加坡华人健康研究中，检查了健康生活方式因素综合评分（包括体重指数、饮酒、吸烟、替代地中海饮食和睡眠时间）与 HCC 风险的关联。采用 Cox 比例风险回归法估计 HR 及其 95%置信区间（CI）。采用条件逻辑回归法评估该综合生活方式评分与乙型肝炎表面抗原（HBsAg）和抗丙型肝炎病毒抗体阴性的一部分个体的 HCC 风险关联。
在平均 17.7 年的随访后，有 561 名参与者发生 HCC。代表更健康生活方式的个体具有更高的综合评分（范围 0-8），其 HCC 风险显著降低。与最低综合评分类别（0-4）相比，综合评分 5、6、7 和 8 的 HR（95%CI）分别为 0.67（0.62-0.85）、0.61（0.48-0.77）、0.49（0.37-0.65）和 0.13（0.06-0.30）（ < 0.0001）。在 HBsAg 阴性和抗丙型肝炎病毒（HCV）阴性血清学的参与者中也观察到类似的负相关（HR，0.38；95%CI，0.19-0.79；最高与最低综合评分类别； = 0.001）。
健康的生活方式可预防 HCC 的发生，尤其是对于无乙型肝炎病毒和丙型肝炎病毒感染的个体。
本研究强调了综合生活方式改变策略在 HCC 一级预防中的重要性。
