title: Primary biliary cirrhosis-associated hepatocellular carcinoma in Chinese patients: incidence and risk factors.
abstract: OBJECTIVE
  To investigate the incidence, characteristics, and risk factors for hepatocellular carcinoma (HCC) in Chinese patients with primary biliary cirrhosis (PBC).
  
  
  METHODS
  We reviewed the data of 52 PBC-associated HCC patients treated at Beijing 302 Hospital from January 2002 to December 2013 and analyzed its incidence and characteristics between the two genders. The risk factors for PBC-associated HCC were analyzed via a case-control study comprising 20 PBC patients with HCC and 77 matched controls without HCC. The matched factors included gender, age, follow-up period and Child-Pugh scores. Conditional logistic regression was used to evaluate the odds ratios of potential risk factors for HCC development. A P < 0.05 was considered statistically significant.
  
  
  RESULTS
  The incidence of HCC in Chinese PBC patients was 4.13% (52/1255) and was significantly higher in the males (9.52%) than in the females (3.31%). Among the 52 PBC patients with HCC, 55.76% (29/52) were diagnosed with HCC and PBC simultaneously, and 5.76% (3/52) were diagnosed with HCC before PBC. The males with PBC-associated HCC were more likely than the females to have undergone blood transfusion (18.75% vs 8.33%, P = 0.043), consumed alcohol (31.25% vs 8.33%, P = 0.010), smoked (31.25% vs 8.33%, P = 0.010), had a family history of malignancy (25% vs 5.56%, P = 0.012), and had serious liver inflammation, as indicated by the elevated levels of alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and γ-glutamyl transpeptidase (P < 0.05). Conditional logistic regression analysis revealed that body mass index (BMI) ≥ 25 [adjusted odds ratio (AOR) = 1.116, 95%CI: 1.002-1.244, P = 0.045] and history of alcohol intake (AOR = 10.294, 95%CI: 1.108-95.680, P = 0.040) were significantly associated with increased odds of HCC development in PBC patients.
  
  
  CONCLUSIONS
  HCC is not rare in Chinese PBC patients. Risk factors for PBC-associated HCC include BMI ≥ 25 and a history of alcohol intake. In addition to regular monitoring, PBC patients may benefit from abstinence from alcohol and body weight control.
authors.affiliation: Xue-Xiu Zhang, Qing-Lei Zeng, Fu-Sheng Wang, The Institute of Translational Hepatology, 302 Military Hospital of China-Peking University Teaching Hospital, Beijing 100039, China.
authors.forename: Xue-Xiu
authors.initials: XX
authors.lastname: Zhang
authors.affiliation: Xue-Xiu Zhang, Qing-Lei Zeng, Fu-Sheng Wang, The Institute of Translational Hepatology, 302 Military Hospital of China-Peking University Teaching Hospital, Beijing 100039, China.
authors.forename: Li-Feng
authors.initials: LF
authors.lastname: Wang
authors.affiliation: Xue-Xiu Zhang, Qing-Lei Zeng, Fu-Sheng Wang, The Institute of Translational Hepatology, 302 Military Hospital of China-Peking University Teaching Hospital, Beijing 100039, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Jin
authors.affiliation: Xue-Xiu Zhang, Qing-Lei Zeng, Fu-Sheng Wang, The Institute of Translational Hepatology, 302 Military Hospital of China-Peking University Teaching Hospital, Beijing 100039, China.
authors.forename: Yuan-Yuan
authors.initials: YY
authors.lastname: Li
authors.affiliation: Xue-Xiu Zhang, Qing-Lei Zeng, Fu-Sheng Wang, The Institute of Translational Hepatology, 302 Military Hospital of China-Peking University Teaching Hospital, Beijing 100039, China.
authors.forename: Shu-Li
authors.initials: SL
authors.lastname: Hao
authors.affiliation: Xue-Xiu Zhang, Qing-Lei Zeng, Fu-Sheng Wang, The Institute of Translational Hepatology, 302 Military Hospital of China-Peking University Teaching Hospital, Beijing 100039, China.
authors.forename: Yan-Chao
authors.initials: YC
authors.lastname: Shi
authors.affiliation: Xue-Xiu Zhang, Qing-Lei Zeng, Fu-Sheng Wang, The Institute of Translational Hepatology, 302 Military Hospital of China-Peking University Teaching Hospital, Beijing 100039, China.
authors.forename: Qing-Lei
authors.initials: QL
authors.lastname: Zeng
authors.affiliation: Xue-Xiu Zhang, Qing-Lei Zeng, Fu-Sheng Wang, The Institute of Translational Hepatology, 302 Military Hospital of China-Peking University Teaching Hospital, Beijing 100039, China.
authors.forename: Zhi-Wei
authors.initials: ZW
authors.lastname: Li
authors.affiliation: Xue-Xiu Zhang, Qing-Lei Zeng, Fu-Sheng Wang, The Institute of Translational Hepatology, 302 Military Hospital of China-Peking University Teaching Hospital, Beijing 100039, China.
authors.forename: Zheng
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: Xue-Xiu Zhang, Qing-Lei Zeng, Fu-Sheng Wang, The Institute of Translational Hepatology, 302 Military Hospital of China-Peking University Teaching Hospital, Beijing 100039, China.
authors.forename: George Kk
authors.initials: GK
authors.lastname: Lau
authors.affiliation: Xue-Xiu Zhang, Qing-Lei Zeng, Fu-Sheng Wang, The Institute of Translational Hepatology, 302 Military Hospital of China-Peking University Teaching Hospital, Beijing 100039, China.
authors.forename: Fu-Sheng
authors.initials: FS
authors.lastname: Wang
mesh_terms: D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects / Q000453:epidemiology; D044466:Asian People; D015992:Body Mass Index; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000453:epidemiology*; D016009:Chi-Square Distribution; D002681:China / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008105:Liver Cirrhosis, Biliary / Q000175:diagnosis / Q000453:epidemiology*; D008113:Liver Neoplasms / Q000175:diagnosis / Q000453:epidemiology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000175:diagnosis / Q000453:epidemiology; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Body mass index; Case-control study; Hepatocellular carcinoma; History of alcohol intake; Primary biliary cirrhosis
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