The association between Clonorchis sinensis infection and hepatocellular carcinoma in an endemic area: a study in Guangxi, China

Abstract

Background Chronic infection with Clonorchis sinensis (C. sinensis) has been associated with the development of intrahepatic cholangiocarcinoma (ICC); however, the relationship between C. sinensis and hepatocellular carcinoma (HCC) remains uncertain. Methods This study examined 120 patients with liver cancer in the clonorchiasis endemic area of Hengzhou, Guangxi, China. The type of cancer, the differentiation grade according to Edmondson Steiner's classification, and the pathological characteristics of HCC were determined through postoperative tissue biopsy. C. sinensis infection was detected by measuring serum specific IgG antibody, and hepatitis B virus (HBV) infection was determined by detecting serum HBsAg and HBV DNA in HCC tissues. Results Of the patients evaluated, 98 (81.7%) had HCC, 21 (17.5%) had ICC, and 1 (0.8%) had comorbidity of HCC/ICC. Among the HCC patients, 24 (24.5%) were solely infected with HBV, 71 (72.4%) were infected with C. sinensis, and 3 (3.1%) showed no evidence of infection. C. sinensis infection rates in HCC patients are much higher than in the general population, as well as in general outpatient and non-liver cancer inpatients in the local area (χ2 = 82.61/141.92, P < 0.001). There were no significant differences in the pathological type, differentiation grade, and lesion composition between the tumor associated with C. sinensis/HBV mono- and co-infection (P > 0.05). Among the patients with C. sinensis-related HCC, 8 (8.2%) were solely infected with C. sinensis, while 63 (64.3%) were co-infected with HBV. Infection with C. sinensis and HBV has a significant impact on the kind of liver cancer (χ2 = 22.858, cramer’V/φ = 0.444, contingency coefficient = 0.406, P < 0.001). Conclusions These findings indicate that HCC still accounts for the majority of liver cancer in this region. In addition to being most commonly related with HBV infection, HCC is also related with C. sinensis infection. The co-infection of HBV and C. sinensis is the leading cause of HCC in this region.