title: Habitual betel quid chewing and risk for hepatocellular carcinoma complicating cirrhosis.
abstract: This case-control study aimed to assess the independent and interactive role of habitual betel quid chewing and known risk factors for hepatocellular carcinoma (HCC). Subjects enrolled included 210 pairs of sex- and age-matched cirrhotic patients with HCC, patients with cirrhosis alone, and healthy controls. Information on risk factors was obtained through serologic examination of hepatitis B surface antigen (HBsAg) and antibodies to hepatitis C virus (anti-HCV), and a standardized personal interview with a structured questionnaire. Multivariate analysis indicated that betel quid chewing (odds ratio [OR], 5.81; 95% confidence interval [CI], 2.26-14.94); HBsAg (OR, 37.98; 95% CI, 19.65-73.42); and anti-HCV (OR, 47.23; 95% CI, 18.86-118.25) were independent risk factors for HCC when HCC patients were compared with healthy controls. Using patients with cirrhosis alone as a reference group, multivariate analysis indicated that only betel quid chewing (OR, 1.69; 95% CI, 1.04-2.76) and HBsAg (OR, 1.54; 95% CI, l.01-2.37) were independent risk factors for HCC. There was an additive interaction between betel quid chewing and the presence of either HBsAg (synergy index, 5.22) or anti-HCV (synergy index, 1.35). Moreover, a higher risk of HCC was associated with a longer duration of betel quid chewing and a larger amount of betel quid consumed (each p(for trend) < 0.0001). In conclusion, betel quid chewing is an independent risk factor for cirrhotic HCC. There is an additive interaction between betel quid chewing and chronic hepatitis B and/or hepatitis C virus infection.
authors.affiliation: From the Department of Internal Medicine, Clinical Laboratory, Biochemistry, and Public Health, Kaohsiung Medical University College of Medicine; the National Health Research Institutes, and the Institute of Biomedical Sciences, Academia Sinica, Taiwan.
authors.forename: Jung-Fa
authors.initials: JF
authors.lastname: Tsai
authors.forename: Jen-Eing
authors.initials: JE
authors.lastname: Jeng
authors.forename: Lee-Yea
authors.initials: LY
authors.lastname: Chuang
authors.forename: Mei-Shang
authors.initials: MS
authors.lastname: Ho
authors.forename: Ying-Chin
authors.initials: YC
authors.lastname: Ko
authors.forename: Zu-Yau
authors.initials: ZY
authors.lastname: Lin
authors.forename: Min-Yuh
authors.initials: MY
authors.lastname: Hsieh
authors.forename: Shin-Chern
authors.initials: SC
authors.lastname: Chen
authors.forename: Wan-Lung
authors.initials: WL
authors.lastname: Chuang
authors.forename: Liang-Yen
authors.initials: LY
authors.lastname: Wang
authors.forename: Ming-Lung
authors.initials: ML
authors.lastname: Yu
authors.forename: Chia-Yen
authors.initials: CY
authors.lastname: Dai
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001114:Areca / Q000009:adverse effects*; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D016022:Case-Control Studies; D005260:Female; D019694:Hepatitis B, Chronic / Q000150:complications; D019698:Hepatitis C, Chronic / Q000150:complications; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications; D008113:Liver Neoplasms / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D008297:Male; D008409:Mastication; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D018515:Plant Leaves / Q000009:adverse effects; D012307:Risk Factors; D012959:Socioeconomic Factors