title: Associations between prescribed Chinese herbal medicine and risk of hepatocellular carcinoma in patients with chronic hepatitis B: a nationwide population-based cohort study.
abstract: Patients with chronic hepatitis B (CHB) are reported to exhibit higher risk of subsequent hepatocellular carcinoma (HCC). However, it remains unclear if Chinese herbal medicine (CHM), an important category of traditional Chinese medicine (TCM), may lower HCC risk in this population. So this study aimed to investigate the effects of CHM on HCC risk among patients with CHB.
  
  
  
  This cohort study used the Taiwanese National Health Insurance Research Database to identify 21 020 newly diagnosed patients with CHB from 1998 to 2007. Among them, 8640 received CHM products after CHB onset (CHM users), and the remaining 12 380 patients were designated as a control group (non-CHM users). All enrolees were followed until the end of 2012 to measure the incidence rate and HR of HCC.
  
  
  
  During 15 years of follow-up, 371 CHM users and 958 non-CHM users developed HCC, representing an incidence rate of 5.28% and 10.18% per 1000 person-years, respectively. CHM users had significantly lower HCC risk compared with non-CHM users (adjusted HR=0.63, 95% CI 0.56 to 0.72). The predominant effect was observed in those receiving CHM products for more than 180 days (adjusted HR=0.52). Some CHM products, such as Hedyotis diffusa, Scutellaria barbata, Rehmannia glutinosa, Isatis tinctoria, Yi Guan Jian, Xiao Chai Hu Tang, Wu Ling San and Gan Lu Yin, were significantly associated with lower risk of HCC.
  
  
  
  The use of CHM was associated with a significantly reduced HCC risk in patients with CHB, which supports the integration of TCM with CHM into clinical practice to influence a favourable prognosis.
authors.affiliation: Department of Medical Research, Dalin Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, Chiayi, Taiwan.|Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.|Department of Nursing, Tzu Chi College of Technology, Hualien, Taiwan.
authors.forename: Tzung-Yi
authors.initials: TY
authors.lastname: Tsai
authors.affiliation: Rehabilitation Counseling Program, Portland State University, Portland, Oregon, USA.
authors.forename: Hanoch
authors.initials: H
authors.lastname: Livneh
authors.affiliation: Division of Gastroenterology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Foundation, Chiayi, Taiwan.|School of Medicine, Tzu Chi University, 701 Jhongyang Road Section 3, Hualien 97004, Taiwan.
authors.forename: Tsung-Hsing
authors.initials: TH
authors.lastname: Hung
authors.affiliation: School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien, Taiwan.
authors.forename: I-Hsin
authors.initials: IH
authors.lastname: Lin
authors.affiliation: School of Medicine, Tzu Chi University, 701 Jhongyang Road Section 3, Hualien 97004, Taiwan.|Division of Allergy, Immunology and Rheumatology, Dalin Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, Chiayi, Taiwan.
authors.forename: Ming-Chi
authors.initials: MC
authors.lastname: Lu
authors.affiliation: School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien, Taiwan.|Department of Chinese Medicine, Dalin Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, Chiayi, Taiwan.
authors.forename: Chia-Chou
authors.initials: CC
authors.lastname: Yeh
mesh_terms: D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology*; D015331:Cohort Studies; D016208:Databases, Factual; D004365:Drugs, Chinese Herbal / Q000627:therapeutic use*; D005260:Female; D019694:Hepatitis B, Chronic / Q000453:epidemiology*; D006801:Humans; D008113:Liver Neoplasms / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D065840:Protective Factors; D012189:Retrospective Studies; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology
chemical_list: D004365:Drugs, Chinese Herbal
keywords: Chinese herbal medicine; chronic hepatitis B; cohort study; hepatocellular carcinoma