Darvishian Maryam, Tang Terry, Wong Stanley, Binka Mawuena, Yu Amanda, Alvarez Maria, Alexander Velásquez García Héctor, Adu Prince Asumadu, Jeong Dahn, Bartlett Sofia, Karamouzian Mohammad, Damascene Makuza Jean, Wong Jason, Ramji Alnoor, Woods Ryan, Krajden Mel, Janjua Naveed, Bhatti Parveen
Cancer Prevention, BC Cancer, Vancouver, BC, Canada.
Cancer Control Research, BC Cancer Research Centre, Vancouver, BC, Canada.
Front Oncol. 2022 Oct 13;12:983238. doi: 10.3389/fonc.2022.983238. eCollection 2022.
Chronic infection with hepatitis C virus (HCV) is an established risk factor for liver cancer. Although several epidemiologic studies have evaluated the risk of extrahepatic malignancies among people living with HCV, due to various study limitations, results have been heterogeneous.
We used data from the British Columbia Hepatitis Testers Cohort (BC-HTC), which includes all individuals tested for HCV in the Province since 1990. We assessed hepatic and extrahepatic cancer incidence using data from BC Cancer Registry. Standardized incidence ratios (SIR) comparing to the general population of BC were calculated for each cancer site from 1990 to 2016.
In total, 56,823 and 1,207,357 individuals tested positive and negative for HCV, respectively. Median age at cancer diagnosis among people with and without HCV infection was 59 (interquartile range (IQR): 53-65) and 63 years (IQR: 54-74), respectively. As compared to people living without HCV, a greater proportion of people living with HCV-infection were men (66.7% vs. 44.7%, P-value <0.0001), had comorbidities (25.0% vs. 16.3%, P-value <0.0001) and were socially deprived (35.9% vs. 25.0%, P-value <0.0001). The SIRs for liver (SIR 33.09; 95% CI 29.80-36.39), anal (SIR: 2.57; 95% CI 1.52-3.63), oesophagus (SIR: 2.00; 95% CI 1.17-2.82), larynx (SIR: 3.24; 95% CI 1.21-5.27), lung (SIR: 2.20; 95% CI 1.82-2.58), and oral (SIR: 1.78; 95% CI 1.33-2.23) cancers were significantly higher among individuals living with HCV. The SIRs for bile duct and pancreatic cancers were significantly elevated among both individuals living with (SIR; 95% CI: 2.20; 1.27-3.14; 2.18; 1.57-2.79, respectively) and without HCV (SIR; 95% CI: 2.12; 1.88-2.36; 1.20; 1.11-1.28, respectively).
DISCUSSION/CONCLUSION: In this study, HCV infection was associated with increased incidence of several extrahepatic cancers. The elevated incidence of multiple cancers among negative HCV testers highlights the potential contributions of screening bias and increased cancer risks associated with factors driving acquisition of infection among this population compared to the general population. Early HCV diagnosis and treatment as well as public health prevention strategies are needed to reduce the risk of extrahepatic cancers among people living with HCV and potentially populations who are at higher risk of HCV infection.
丙型肝炎病毒（HCV）慢性感染是肝癌的既定危险因素。尽管多项流行病学研究评估了HCV感染者发生肝外恶性肿瘤的风险，但由于各种研究局限性，结果并不一致。
我们使用了不列颠哥伦比亚省肝炎检测队列（BC-HTC）的数据，该队列包括自1990年以来在该省接受HCV检测的所有个体。我们使用BC癌症登记处的数据评估了肝癌和肝外癌症的发病率。计算了1990年至2016年每个癌症部位与不列颠哥伦比亚省普通人群相比的标准化发病率（SIR）。
总共有56,823人和1,207,357人HCV检测呈阳性和阴性。HCV感染组和未感染组癌症诊断时的中位年龄分别为59岁（四分位间距（IQR）：53 - 65岁）和63岁（IQR：54 - 74岁）。与未感染HCV的人相比，HCV感染人群中男性比例更高（66.7%对44.7%，P值<(0.0001)），有合并症的比例更高（25.0%对16.3%，P值<(0.0001)），且社会经济地位较低（35.9%对25.0%，P值<(0.0001)）。HCV感染者中肝癌（SIR 33.09；95%置信区间29.80 - 36.39）、肛门癌（SIR：2.57；95%置信区间1.52 - 3.63）、食管癌（SIR：2.00；95%置信区间1.17 - 2.82）、喉癌（SIR：3.24；95%置信区间1.21 - 5.27）、肺癌（SIR：2.20；95%置信区间1.82 - 2.58）和口腔癌（SIR：1.78；95%置信区间1.33 - 2.23）的标准化发病率显著更高。HCV感染者和未感染者中胆管癌和胰腺癌的标准化发病率均显著升高（分别为SIR；95%置信区间：2.20；1.27 - 3.14；2.18；1.57 - 2.79和SIR；95%置信区间：2.12；1.88 - 2.36；1.20；1.11 - 1.28）。
讨论/结论：在本研究中，HCV感染与多种肝外癌症发病率增加相关。HCV检测阴性者中多种癌症发病率升高凸显了筛查偏倚的潜在影响，以及与该人群相比普通人群中因导致感染的因素而增加的癌症风险。需要早期HCV诊断和治疗以及公共卫生预防策略，以降低HCV感染者以及潜在的HCV感染高危人群发生肝外癌症的风险。
