title: Risk factors for hepatocellular carcinoma in patients with chronic liver disease: a case-control study.
abstract: The majority of data on risk factors (RFs) for hepatocellular carcinoma (HCC) comes from studies involving populations without underlying liver disease. It is important to evaluate RFs for HCC in patients with chronic liver disease since HCC rarely occurs in those without underlying liver disease. We conducted a hospital-based case-control study of 259 incident HCC cases and 781 controls by convenience sampling between 02/2001 and 12/2009 from the liver clinic at Stanford University Medical Center. The study population was 41% White, 14% Hispanic, 3% African American, 40% Asian American, and 2% other race/ethnicity. RFs were examined through medical records and an in-person questionnaire. Alcohol and tobacco use was calculated by cumulative grams of alcohol or cumulative pack(s) of cigarette consumed over one's lifetime. Diabetes mellitus (DM) was defined by random glucose level of ≥200 mg/dL. RFs were evaluated using multivariate logistic regression. Independent predictors of HCC risk, after mutual adjustment and additional control for alcohol use, etiology of liver diseases, and DM, included age >40 (OR = 8.5 [2.6-28.3]), male gender (OR = 3.5 [2.2-5.8]), presence of cirrhosis (OR = 2.8 [1.6-4.9]), Asian ethnicity (OR = 2.8 [1.8-4.6]), AFP > 50 (OR = 4.2 [2.6-6.8]), and cumulative lifetime tobacco use of >11,000 packs (OR = 1.7 [1.0-2.9]). Heavy prolonged cigarette smoking, but not alcohol use, was a significant independent predictor for HCC in patients with underlying liver disease. Besides older age, male gender, presence of cirrhosis, and elevated AFP, Asian ethnicity and heavy cumulative tobacco use are strong independent predictors of HCC.
authors.affiliation: Pacific Health Foundation, San Jose, CA, USA.
authors.forename: Nghi B
authors.initials: NB
authors.lastname: Ha
authors.forename: Nghiem B
authors.initials: NB
authors.lastname: Ha
authors.forename: Aijaz
authors.initials: A
authors.lastname: Ahmed
authors.forename: Walid
authors.initials: W
authors.lastname: Ayoub
authors.forename: Tami J
authors.initials: TJ
authors.lastname: Daugherty
authors.forename: Ellen T
authors.initials: ET
authors.lastname: Chang
authors.forename: Glen A
authors.initials: GA
authors.lastname: Lutchman
authors.forename: Gabriel
authors.initials: G
authors.lastname: Garcia
authors.forename: Allen D
authors.initials: AD
authors.lastname: Cooper
authors.forename: Emmet B
authors.initials: EB
authors.lastname: Keeffe
authors.forename: Mindie H
authors.initials: MH
authors.lastname: Nguyen
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000009:adverse effects; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology* / Q000208:ethnology; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D002908:Chronic Disease; D005006:Ethnicity; D005260:Female; D006801:Humans; D008019:Life Style; D008103:Liver Cirrhosis / Q000150:complications; D008113:Liver Neoplasms / Q000453:epidemiology* / Q000208:ethnology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking; D013223:Statistics as Topic; D013997:Time Factors; D014481:United States / Q000453:epidemiology