Association between HBsAg positivity and pancreatic cancer: a meta-analysis.
BACKGROUND
Several studies have proposed an association between hepatitis B and pancreatic cancer. Although the spectrum of serological tests varied between studies, hepatitis B virus (HBV) surface antigen (HBsAg) test results were consistently reported. This meta-analysis evaluates the association between HBsAg positivity and pancreatic cancer.


METHODS
A systematic literature search was performed from inception through September 2013 for English language studies using the following terms: "hepatitis B," "HBsAg," "pancreatic cancer," and "pancreatic adenocarcinoma." Studies that have not reported cumulative odds ratio for the association of interest were excluded. Pooled odds ratios (ORs) and corresponding 95% confidence intervals (CI) were calculated using a random-effects model. Statistical heterogeneity and publication bias were addressed using the I2 statistic and Egger's weighted regression statistics, respectively.


RESULTS
We included two case-control studies and one cohort study, involving 1,636 patients with pancreatic cancer. The OR of developing pancreatic cancer was 1.50 (95% CI 1.21 to 1.87) for individuals who were HBsAg-positive. The type of study, case-control versus cohort, did not appear to influence the results. Only two of the three studies reported the association between anti-HBc positivity and pancreatic cancer. Our analysis revealed a nonsignificant increased risk of cancer in patients with positive anti-HBc status (OR 1.23, 95% CI 0.95-1.59). No statistically significant heterogeneity or publication bias was noted.


CONCLUSIONS
HBsAg positivity is associated with an increased risk of pancreatic cancer. Additional studies are needed to clearly define the association between chronic hepatitis B infection and pancreatic cancer. This could have important implications for both primary prevention and treatment of pancreatic cancer.
Department of Internal Medicine, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT, 06032, USA.
Shounak
S
Majumder
Bruno
B
Bockorny
William L
WL
Baker
Constantin A
CA
Dasanu
D000230:Adenocarcinoma / Q000097:blood / Q000453:epidemiology*; D016022:Case-Control Studies; D002681:China / Q000453:epidemiology; D015897:Comorbidity; D004198:Disease Susceptibility; D006509:Hepatitis B / Q000097:blood / Q000453:epidemiology*; D006514:Hepatitis B Surface Antigens / Q000097:blood*; D006801:Humans; D016017:Odds Ratio; D010190:Pancreatic Neoplasms / Q000097:blood / Q000453:epidemiology*; D011446:Prospective Studies; D012306:Risk; D016036:Seroepidemiologic Studies; D013624:Taiwan / Q000453:epidemiology
D006514:Hepatitis B Surface Antigens