title: Association between hepatitis B or hepatitis C virus infection and risk of pancreatic adenocarcinoma development: a systematic review and meta-analysis.
abstract: BACKGROUND
  Pancreatic adenocarcinoma (PAC) is an aggressive cancer with a poor prognosis. To date, PAC causes are still largely unknown. Antigens and replicative sequences of oncogenic hepatitis B (HBV) and hepatitis C (HCV) virus were detected in different extra-hepatic tissues, including pancreas.
  
  
  OBJECTIVE
  a systematic review and meta-analysis of epidemiological studies assessing PAC risk in patients with HBV/HCV chronic infections.
  
  
  METHODS
  In September 2012, we extracted the articles published in Medline, Embase and the Cochrane Library, using the following search terms: "chronic HBV" and "HCV", "hepatitis", "PAC", "risk factors", "epidemiology". Only case/control (C/C), prospective/retrospective cohort studies (PCS/RCS) written in English were collected.
  
  
  RESULTS
  four hospital-based C/C studies and one PCS, in HBV-infected patients and two hospital-based C/C studies and one RCS in HCV-infected subjects met inclusion criteria. In these studies HBsAg positivity enhanced significantly PAC risk (RR = 1.18, 95% CI:1.04-1.33), whereas HBeAg positivity (RR = 1.31, 95% CI:0.85-2.02) as well as HBsAg negative/HBcAb positive/HBsAb positive pattern (RR = 1.12, 95% CI:0.78-1.59) and HBsAg negative/HBcAb positive/HBsAb negative pattern (RR = 1.30, 95% CI:0.93-1.84) did not. Relationship between PAC risk and anti-HCV positivity was not significant, although it reached a borderline value (RR = 1.160, 95% CI:0.99-1.3).
  
  
  CONCLUSIONS
  HBV/HCV infection may represent a risk factor for PAC, but the small number of available researches, involving mainly populations of Asian ethnicity and the substantial variation between different geographical areas in seroprevalence of HBV/HCV-antigens/antibodies and genotypes are limiting factors to present meta-analysis.
authors.affiliation: Unità Operativa di Medicina Interna, Ospedale di Budrio, Via Benni 44, 40065 Budrio, Bologna, Italy. sirio.fiorino@ausl.bologna.it
authors.forename: S
authors.initials: S
authors.lastname: Fiorino
authors.forename: E
authors.initials: E
authors.lastname: Chili
authors.forename: L
authors.initials: L
authors.lastname: Bacchi-Reggiani
authors.forename: M
authors.initials: M
authors.lastname: Masetti
authors.forename: G
authors.initials: G
authors.lastname: Deleonardi
authors.forename: A G
authors.initials: AG
authors.lastname: Grondona
authors.forename: T
authors.initials: T
authors.lastname: Silvestri
authors.forename: E
authors.initials: E
authors.lastname: Magrini
authors.forename: N
authors.initials: N
authors.lastname: Zanini
authors.forename: A
authors.initials: A
authors.lastname: Cuppini
authors.forename: R
authors.initials: R
authors.lastname: Nardi
authors.forename: E
authors.initials: E
authors.lastname: Jovine
mesh_terms: D000230:Adenocarcinoma / Q000209:etiology* / Q000821:virology; D006509:Hepatitis B / Q000150:complications* / Q000821:virology; D006526:Hepatitis C / Q000150:complications* / Q000821:virology; D006801:Humans; D010190:Pancreatic Neoplasms / Q000209:etiology* / Q000821:virology