Cigarette Smoking, Alcohol Drinking, Hepatitis B, and Risk for Hepatocellular Carcinoma in Korea

Jee, Sun Ha; Ohrr, Heechoul; Sull, Jae Woong; Samet, Jonathan M.

doi:10.1093/jnci/djh334

Cited by 198 publications

(152 citation statements)

References 12 publications

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“…[7][8][9][11][12][13] In our study, at ethanol intakes of 46 g/day or more, the data are strongly supportive of an association between alcohol consumption and poor survival in HCC patients. The relationship between cigarette smoking and the development of HCC has been examined in many studies in both low-and high-incidence HCC areas and the results have been mixed, [6][7][8][9][10][11] but evidence for a role of smoking in the etiology of HCC has been noted in two large prospective cohort studies conducted in areas where HBV infection is common. 6,7 Consistent with our study, a previous cohort study based on data collected as part of an insurance plan with a mean follow-up of 3 years has also indicated a deleterious effect of both smoking and alcohol consumption on survival in HCC.…”

Section: Discussionsupporting

confidence: 81%

“…24 Chronic heavy alcohol drinking, defined as 60-80 g/day for prolonged period, is a cause of liver cirrhosis and an important risk factor for progression through cirrhosis to HCC. 7,9,[11][12][13][14] However, there is controversy about the magnitude of HCC risk associated with low to moderate alcohol intake. [7][8][9][11][12][13] In our study, at ethanol intakes of 46 g/day or more, the data are strongly supportive of an association between alcohol consumption and poor survival in HCC patients.…”

Section: Discussionmentioning

confidence: 99%

“…7,9,[11][12][13][14] However, there is controversy about the magnitude of HCC risk associated with low to moderate alcohol intake. [7][8][9][11][12][13] In our study, at ethanol intakes of 46 g/day or more, the data are strongly supportive of an association between alcohol consumption and poor survival in HCC patients. The relationship between cigarette smoking and the development of HCC has been examined in many studies in both low-and high-incidence HCC areas and the results have been mixed, [6][7][8][9][10][11] but evidence for a role of smoking in the etiology of HCC has been noted in two large prospective cohort studies conducted in areas where HBV infection is common.…”

Section: Discussionmentioning

confidence: 99%

“…[6][7][8][9][10][11][12] Heavy drinking is a major cause of liver cirrhosis, 13,14 which underlies HCC and contributes to poor prognosis of HCC. [2][3][4]11 Tobacco-related carcinogens can initiate liver tumor formation and inactivate tumor suppressor genes via promoter hypermethylation or mutation in animal models, [15][16][17][18][19] yet the information on the role of prediagnostic smoking in HCC survival is limited.…”

mentioning

confidence: 99%

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Influences of tobacco and alcohol use on hepatocellular carcinoma survival

Shih

Chang

Liaw

et al. 2012

Intl Journal of Cancer

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Prognosis of hepatocellular carcinoma (HCC) is generally poor. The role of modifiable lifestyle factors on HCC survival has been less studied. To examine whether prediagnosis smoking and alcohol affected HCC survival stratified by viral etiology, we conducted a prospective cohort study of 2,273 (1990 with viral hepatitis and 283 without) incident HCC cases aged 20-75 years who were enrolled between 1997 and 2004 from a Taiwanese multicenter study, and followed up through 2007. Information on habitual smoking and alcohol consumption was obtained at baseline through personal interview. After follow-up to a maximum of 10 years, 1,757 participants died and 1,488 (84.7%) were attributed to HCC. Prediagnosis smoking and alcohol worsened prognosis independent of each other and clinical predictors. The effects of both risky behaviors were limited to viral hepatitis-related HCC and more profound among those with early-stage HCC. Risk for HCC-specific mortality increased with increasing pack-years smoked and ethanol intake (all p < 0.001 for trend), with an additive effect shown for the two habits [hazard ratio (HR) for alcohol 46.2 g/day and 10 pack-years 5 1.72, 95% confidence interval (CI) 5 1.45-2.05]. For either habit, cessation reduced HCC-specific mortality, but a significant mortality benefit occurred 10 years after abstinence (quitting smoking 10 years vs. continuing smokers: HR 5 0.77, 95% CI 5 0.61-0.97; quitting drinking 10 years vs. continuing drinkers: HR 5 0.74, 95% CI 5 0.56-0.98). In conclusion, among patients with viral hepatitis-related HCC, prediagnosis smoking and alcohol have a deleterious effect on HCC survival. Quitting smoking or drinking alcohol could reduce the excess risk, but only after a long interval of cessation.Hepatocellular carcinoma (HCC) is one of the world's leading cancer threats associated with death.1 The prognosis of advanced HCC remains poor. With marked improvement in the early detection and management of HCC during recent decades; however, up to around 60% of early-stage HCC patients may survive without recurrence for 5 or even 7 years.2-4 Established prognostic predictors include the degrees of liver damage, tumor burden and serum a-fetoprotein values.2-4 Although many studies have addressed these and other prognostic factors, 2-5 there has been limited exploration of the influence of modifiable lifestyle factors on HCC prognosis.Both alcohol consumption and cigarette smoking have been associated with increased risk of HCC in many epidemiological studies, although the results are somewhat inconsistent.6-12 Heavy drinking is a major cause of liver cirrhosis, 13,14 which underlies HCC and contributes to poor prognosis of HCC.2-4,11 Tobacco-related carcinogens can initiate liver tumor formation and inactivate tumor suppressor genes via promoter hypermethylation or mutation in animal models, [15][16][17][18][19] yet the information on the role of prediagnostic smoking in HCC survival is limited. 20 Whether smoking cessation can improve survival rates remains unclear.Using a multic...

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Influences of tobacco and alcohol use on hepatocellular carcinoma survival

Shih

Chang

Liaw

et al. 2012

Intl Journal of Cancer

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“…Large population-based cohort studies performed in East Asia showed no interaction between alcohol consumption and HBV infection on HCC risk (Yu et al, 1997;Sun et al, 1999;Evans et al, 2002;Wang et al, 2003;Jee et al, 2004). Low levels of alcohol consumption were, however, defined in these studies for 'exposed' subjects: 25 g/day (Jee et al, 2004), 'habitual' or 'weekly' consumption (Yu et al, 1997;Sun et al, 1999;Evans et al, 2002;Wang et al, 2003). Therefore, no conclusion can be drawn from these studies on the interaction between medium-high alcohol intake and HBV infection.…”

Section: Interaction With Hepatitis B Virusmentioning

confidence: 99%

Southern Europe as an example of interaction between various environmental factors: a systematic review of the epidemiologic evidence

et al. 2006

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Hepatitis B virus (HBV), hepatitis C virus (HCV) and alcohol consumption are major causes of hepatocellular carcinoma (HCC) worldwide. We performed a systematic review of epidemiologic studies carried out on HCC aetiology in Southern Europe, an area with an intermediatehigh prevalence of these agents as well as of putative risk factors such as tobacco smoking, diabetes and obesity. To retrieve the articles, we performed a Medline search for titles and abstracts of articles. After the Medline search, we reviewed the papers and reference lists to identify additional articles. A synergism between HCV infection and HBV infection, overt (hepatitis B virus antigen (HbsAg) positivity) or occult (HBsAg negativity with presence of HBV DNA in liver or serum), is suggested by the results of some studies. The pattern of the risk for HCC due to alcohol intake shows a continuous dose-effect curve without a definite threshold, although most studies found that HCC risk increased only for alcohol consumption above 40-60 g of ethanol per day. Some evidence supports a positive interaction of alcohol intake probably with HCV infection and possibly with HBV infection. A few studies found that coffee has a protective effect on HCC risk due to various risk factors. Some data also support a role of tobacco smoking, diabetes and obesity as single agents or preferably cofactors in causing HCC. In countries with a relatively high alcohol consumption and intermediate levels of HCV and HBV infections (1-3% of population infected by each virus), such as Mediterranean countries, the three main risk factors together account for about 85% of the total HCC cases, leaving little space to other known risk factors, such as haemochromatosis, and to new, still unrecognised, factors as independent causes of HCC.

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Fasting Serum Glucose Level and Cancer Risk in Korean Men and Women

2005

JAMA

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Cigarette Smoking, Alcohol Drinking, Hepatitis B, and Risk for Hepatocellular Carcinoma in Korea

Cited by 198 publications

References 12 publications

Influences of tobacco and alcohol use on hepatocellular carcinoma survival

Influences of tobacco and alcohol use on hepatocellular carcinoma survival

Southern Europe as an example of interaction between various environmental factors: a systematic review of the epidemiologic evidence

Fasting Serum Glucose Level and Cancer Risk in Korean Men and Women

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