title: Possible association between hepatitis C virus and malignancies different from hepatocellular carcinoma: A systematic review.
abstract: OBJECTIVE
  To summarize the current knowledge about the potential relationship between hepatitis C virus (HCV) infection and the risk of several extra-liver cancers.
  
  
  METHODS
  We performed a systematic review of the literature, according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) Statement. We extracted the pertinent articles, published in MEDLINE and the Cochrane Library, using the following search terms: neoplasm/cancer/malignancy/tumor/carcinoma/adeno-carcinoma and non-Hodgkin lymphomas, kidney/renal-, cholangio-, pancreatic-, thyroid-, breast-,oral-, skin-, prostate-, lung-, colon-, stomach-, haematologic. Case series, case-series with control-group, case-control, cohort-studies as well as meta-analyses, written in English were collected. Some of the main characteristics of retrieved trials, which were designed to investigate the prevalence of HCV infection in each type of the above-mentioned human malignancies were summarised. A main table was defined and included a short description in the text for each of these tumours, whether at least five studies about a specific neoplasm, meeting inclusion criteria, were available in literature. According to these criteria, we created the following sections and the corresponding tables and we indicated the number of included or excluded articles, as well as of meta-analyses and reviews: (1) HCV and haematopoietic malignancies; (2) HCV and cholangiocarcinoma; (3) HCV and pancreatic cancer; (4) HCV and breast cancer; (5) HCV and kidney cancer; (6) HCV and skin or oral cancer; and (7) HCV and thyroid cancer.
  
  
  RESULTS
  According to available data, a clear correlation between regions of HCV prevalence and risk of extra-liver cancers has emerged only for a very small group of types and histological subtypes of malignancies. In particular, HCV infection has been associated with: (1) a higher incidence of some B-cell Non-Hodgkin-Lymphoma types, in countries, where an elevated prevalence of this pathogen is detectable, accounting to a percentage of about 10%; (2) an increased risk of intra-hepatic cholangiocarcinoma; and (3) a correlation between HCV prevalence and pancreatic cancer (PAC) incidence.
  
  
  CONCLUSIONS
  To date no definitive conclusions may be obtained from the analysis of relationship between HCV and extra-hepatic cancers. Further studies, recruiting an adequate number of patients are required to confirm or deny this association.
authors.affiliation: Sirio Fiorino, Andrea Cuppini, Unità Operativa di Medicina Interna, Ospedale di Budrio, Budrio, 40054 Bologna, Italy.
authors.forename: Sirio
authors.initials: S
authors.lastname: Fiorino
authors.affiliation: Sirio Fiorino, Andrea Cuppini, Unità Operativa di Medicina Interna, Ospedale di Budrio, Budrio, 40054 Bologna, Italy.
authors.forename: Letizia
authors.initials: L
authors.lastname: Bacchi-Reggiani
authors.affiliation: Sirio Fiorino, Andrea Cuppini, Unità Operativa di Medicina Interna, Ospedale di Budrio, Budrio, 40054 Bologna, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: de Biase
authors.affiliation: Sirio Fiorino, Andrea Cuppini, Unità Operativa di Medicina Interna, Ospedale di Budrio, Budrio, 40054 Bologna, Italy.
authors.forename: Adele
authors.initials: A
authors.lastname: Fornelli
authors.affiliation: Sirio Fiorino, Andrea Cuppini, Unità Operativa di Medicina Interna, Ospedale di Budrio, Budrio, 40054 Bologna, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Masetti
authors.affiliation: Sirio Fiorino, Andrea Cuppini, Unità Operativa di Medicina Interna, Ospedale di Budrio, Budrio, 40054 Bologna, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Tura
authors.affiliation: Sirio Fiorino, Andrea Cuppini, Unità Operativa di Medicina Interna, Ospedale di Budrio, Budrio, 40054 Bologna, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Grizzi
authors.affiliation: Sirio Fiorino, Andrea Cuppini, Unità Operativa di Medicina Interna, Ospedale di Budrio, Budrio, 40054 Bologna, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Zanello
authors.affiliation: Sirio Fiorino, Andrea Cuppini, Unità Operativa di Medicina Interna, Ospedale di Budrio, Budrio, 40054 Bologna, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Mastrangelo
authors.affiliation: Sirio Fiorino, Andrea Cuppini, Unità Operativa di Medicina Interna, Ospedale di Budrio, Budrio, 40054 Bologna, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Lombardi
authors.affiliation: Sirio Fiorino, Andrea Cuppini, Unità Operativa di Medicina Interna, Ospedale di Budrio, Budrio, 40054 Bologna, Italy.
authors.forename: Giorgia
authors.initials: G
authors.lastname: Acquaviva
authors.affiliation: Sirio Fiorino, Andrea Cuppini, Unità Operativa di Medicina Interna, Ospedale di Budrio, Budrio, 40054 Bologna, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: di Tommaso
authors.affiliation: Sirio Fiorino, Andrea Cuppini, Unità Operativa di Medicina Interna, Ospedale di Budrio, Budrio, 40054 Bologna, Italy.
authors.forename: Arrigo
authors.initials: A
authors.lastname: Bondi
authors.affiliation: Sirio Fiorino, Andrea Cuppini, Unità Operativa di Medicina Interna, Ospedale di Budrio, Budrio, 40054 Bologna, Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Visani
authors.affiliation: Sirio Fiorino, Andrea Cuppini, Unità Operativa di Medicina Interna, Ospedale di Budrio, Budrio, 40054 Bologna, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Sabbatani
authors.affiliation: Sirio Fiorino, Andrea Cuppini, Unità Operativa di Medicina Interna, Ospedale di Budrio, Budrio, 40054 Bologna, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Pontoriero
authors.affiliation: Sirio Fiorino, Andrea Cuppini, Unità Operativa di Medicina Interna, Ospedale di Budrio, Budrio, 40054 Bologna, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Fabbri
authors.affiliation: Sirio Fiorino, Andrea Cuppini, Unità Operativa di Medicina Interna, Ospedale di Budrio, Budrio, 40054 Bologna, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Cuppini
authors.affiliation: Sirio Fiorino, Andrea Cuppini, Unità Operativa di Medicina Interna, Ospedale di Budrio, Budrio, 40054 Bologna, Italy.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Pession
authors.affiliation: Sirio Fiorino, Andrea Cuppini, Unità Operativa di Medicina Interna, Ospedale di Budrio, Budrio, 40054 Bologna, Italy.
authors.forename: Elio
authors.initials: E
authors.lastname: Jovine
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000821:virology; D016174:Hepacivirus / Q000472:pathogenicity*; D006526:Hepatitis C / Q000175:diagnosis / Q000453:epidemiology / Q000821:virology*; D006801:Humans; D008113:Liver Neoplasms / Q000821:virology; D009369:Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000821:virology*; D018570:Risk Assessment; D012307:Risk Factors
keywords: Cancer; Cholangiocarcinoma; Extra-hepatic malignancies; Hepatitis C virus; Hepatocellular carcinoma; Neoplasm; Pancreatic cancer; Risk factors