ElTelbany Ahmed, Khoudari George, Al-Khadra Yasser, McCullough Arthur, Alkhouri Naim
Internal Medicine, Cleveland Clinic, Cleveland, USA.
Gastroenterology and Hepatology, MedStar Georgetown University Hospital, Washington DC, USA.
Cureus. 2022 Apr 28;14(4):e24576. doi: 10.7759/cureus.24576. eCollection 2022 Apr.
Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide and the fourth leading cause of cancer deaths in the world. The association between HCC and cannabis has been identified in mice; however, to our knowledge has not been identified in humans. Therefore, we aim to investigate the relation between HCC and cannabis use in humans.
Using data from the National Inpatient Sample (NIS) database between 2002 and 2014, we identified the patients with HCC and cannabis use diagnosis using the International Classification of Disease 9 version codes (ICD-9). Then, we identified patients without cannabis use as the control group. We adjusted for multiple potential confounders and performed multivariable logistic regression analysis to determine the association between cannabis abuse and HCC.
A total of 101,231,036 patients were included in the study. Out of the total, 996,290 patients (1%) had the diagnosis of cannabis abuse versus 100,234,746 patients (99%) in the control group without cannabis abuse. We noticed that patients with cannabis abuse were younger (34 vs 48 years), had more males (61.7% vs 41.4%) and more African Americans (29.9% vs 14.2%) compared with the control group (P<0.001 for all). Besides, patients with cannabis use had more hepatitis B, hepatitis C, liver cirrhosis, and smoking, but had less obesity and gallstones, (P<0.001 for all). Using multivariable logistic regression, and after adjusting for potential confounders, patients with cannabis abuse were 55% less likely to have HCC (adjusted Odds Ratio {aOR}, 0.45, 95% Confidence Interval {CI}, 0.42-0.49, P<0.001) compared with patients without cannabis abuse.
Based on our large database analysis, we found that cannabis use patients were 55% less likely to have HCC compared to patients without cannabis use. Further prospective studies are needed to assess the role of cannabis use on HCC.
肝细胞癌（HCC）是全球最常见的恶性肿瘤之一，也是全球癌症死亡的第四大主要原因。HCC与大麻之间的关联已在小鼠中得到证实；然而，据我们所知，尚未在人类中得到证实。因此，我们旨在研究人类中HCC与大麻使用之间的关系。
利用2002年至2014年国家住院样本（NIS）数据库中的数据，我们使用国际疾病分类第9版代码（ICD-9）确定了患有HCC且有大麻使用诊断的患者。然后，我们确定没有大麻使用的患者作为对照组。我们对多个潜在混杂因素进行了调整，并进行了多变量逻辑回归分析，以确定大麻滥用与HCC之间的关联。
共有101231036名患者纳入研究。其中，996290名患者（1%）被诊断为大麻滥用，而对照组中没有大麻滥用的患者有100234746名（99%）。我们注意到，与对照组相比，大麻滥用患者更年轻（34岁对48岁），男性更多（61.7%对41.4%），非裔美国人更多（29.9%对14.2%）（所有P<0.001）。此外，使用大麻的患者乙型肝炎、丙型肝炎、肝硬化和吸烟更多，但肥胖和胆结石更少（所有P<0.001）。使用多变量逻辑回归，并在调整潜在混杂因素后，与没有大麻滥用的患者相比，大麻滥用患者患HCC的可能性降低了55%（调整后的优势比{aOR}为0.45，95%置信区间{CI}为0.42-0.49，P<0.001）。
基于我们的大型数据库分析，我们发现与不使用大麻的患者相比，使用大麻的患者患HCC的可能性降低了55%。需要进一步的前瞻性研究来评估大麻使用对HCC的作用。
