Risk of hepatobiliary and pancreatic cancers after hepatitis C virus infection: A population-based study of U.S. veterans

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http://www3.interscience.wiley.com/journal/121393933/abstract

Hepatology

Published Online: 2 Sep 2008

Hepatobiliary Malignancies

Risk of hepatobiliary and pancreatic cancers after hepatitis C virus infection:

A population-based study of U.S. veterans

Hashem B. El-Serag 1 2 *, A. Engels 3, Ola Landgren 3, Chiao 1 2,

Louise 1 2, Harshinie C. Amaratunge 1 2, P. Giordano 1 2

1Department of Medicine, Baylor College of Medicine, Houston, TX

2Houston Center for Quality of Care and Utilization Studies, Health Services

Research and Development Service, Department of Veterans Affairs Medical Center,

Houston, TX

3Division of Cancer Epidemiology and Genetics, National Cancer Institute,

National Institutes of Health, Rockville, MD

email: Hashem B. El-Serag (hasheme@...)

*Correspondence to Hashem B. El-Serag, Houston VA Medical Center (152), 2002

Holcombe Boulevard, Houston, TX 77030

Potential conflict of interest: Nothing to report.

fax:713 748 7359

Funded by:

Intramural Program of the National Cancer Institute, National Institutes of

Health

E. DeBakey Veterans Affairs Medical Center, Department of Veterans

Affairs, Houston, TX

NIH; Grant Number: K24 DK078154-01

Abstract

Hepatitis C virus (HCV) may increase the risk of hepatopancreaticobiliary tumors

other than hepatocellular carcinoma (HCC). Previous case control studies

indicated a possible association between HCV and intrahepatic cholangiocarcinoma

(ICC). Little is known about the association between HCV and extrahepatic

cholangiocarcinoma (ECC) or pancreatic cancer. We conducted a cohort study

including 146,394 HCV-infected and 572,293 HCV-uninfected patients who received

care at Veterans Affairs health care facilities. Patients with two visits

between 1996 and 2004 with HCV infection were included, as were up to four

matched HCV-uninfected subjects for each HCV-infected subject. Risks of ICC,

ECC, pancreatic cancer, and HCC were assessed using proportional hazards

regression. In the 1.37 million person-years of follow-up, which began 6 months

after the baseline visit, there were 75 cases of ECC, 37 cases of ICC, 617 cases

of pancreatic cancer, and 1679 cases of HCC. As expected, the risk of HCC

associated with HCV was very high (hazard ratio

---

, 15.09; 95% confidence

interval [95% CI], 13.44, 16.94). Risk for ICC was elevated with HCV infection

2.55; 1.31, 4.95), but risk for ECC was not significantly increased (1.50; 0.60,

1.85). Adjustments for cirrhosis, diabetes, inflammatory bowel disease,

hepatitis B, alcoholism, and alcoholic liver disease did not reduce the risk for

ICC below twofold. The risk of pancreatic cancer was slightly elevated (1.23;

1.02, 1.49), but was attenuated after adjusting for alcohol use, pancreatitis,

and other variables. Conclusions: Findings indicated that HCV infection

conferred a more than twofold elevated risk of ICC. Absence of an association

with ECC was consistent in adjusted and unadjusted models. A significant

association with pancreatic cancer was erased by alcohol use and other

variables. (HEPATOLOGY 2008.)

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Received: 29 February 2008; Accepted: 24 August 2008

Digital Object Identifier (DOI)

10.1002/hep.22606