Chronic hepatitis C can be managed with medications and even cured, but it’s still a serious condition. Each comorbid condition influences the risk of HCC by varying degrees, and multiple conditions might interact in complex ways. While including diabetes in the models suggested an increase in the risk of comparable magnitude, the difference was not sufficiently significant to remain in the final model, suggesting that in our cohort, this is a low-risk condition relative to other factors considered. To clarify the effect of diabetes on HCC risk, the team examined a health insurance database covering the years 2000 to 2005 and used the information to compare 19,349 newly diagnosed diabetes patients with 77,396 matched controls. Dr. Lai of China Medical University, Taichung and colleagues note that there is accumulating evidence that patients with diabetes mellitus are more prone to cancer in general and liver cancer in particular. Antiviral therapy has been shown to limit the progression of liver disease, and in some HBV cases, can reverse decompensated cirrhosis, considerably reducing the risk of HCC. Thus, antiviral therapy of chronic viral hepatitis represents a pivotal pathway for reducing the burden of HCC.
In light of its ability to detect tumors early and improve treatment eligibility and survival, screening and surveillance play a key role in reducing the burden of HCC. Several key factors emerged as independent. Identifying and quantifying risk factors specific to a population, as we have done, forms an integral part of targeting cost-effective surveillance and provides motivation for more widespread screening of high-risk groups. However, in terms of identifying high-risk individuals, the comorbidity score quantifies the combined effect of multiple conditions, without the need to interpret risks associated with multiple factors and their interactions. The observed increased risk of HCC among those with HBV/HCV co-infection is consistent with other studies, which found that the combined effect of the two infections is more than additive, but less than multiplicative. In addition to the two completed studies, Sirtex also released updates regarding a larger, independent global study currently enrolling patients at 40 sites including several in the United States. Two studies based in Taiwan found a 12-fold and 50-fold increase in risk due to cirrhosis among a HBV-infected cohort. Highlights include the results of two independent studies in Belgium and Italy published recently in the Journal of Clinical Oncology and the British Journal of Cancer, respectively.
Few studies have assessed the association between comorbidity score and HCC risk, as it is often more informative to examine individual health conditions. Having a hospital record for both conditions likely indicates advanced or rapidly-progressing liver disease. HBV patients with a new diagnosis will be assessed for whether they can be monitored to ensure they remain in a stable disease state, or they may need to start treatment. A further limitation was the availability of cirrhosis data only through hospitalization codes, particularly as liver biopsy and hepatic elastography diagnosis are generally undertaken through outpatient services. More limited access to specific HCC diagnostic services in non-metropolitan areas might also be a factor in producing an apparently lower incidence of HCC. The incidence of HCC increased with age and comorbidity score, and was higher among males, metropolitan residents, and those with ALD, and particularly cirrhosis. Initially, only deaths from acute infections were taken into account for measuring mortality; however, it ignored mortalities associated with chronic liver disease that resulted from hepatitis virus infection, such as cirrhosis and HCC. Any factor that decreases the oxygen level in the body, such as lung disease or anemia (low number of RBCs), increases the level of erythropoietin in the body.
When a transfusion reaction occurs, an antibody attaches to antigens on several RBCs. A reaction occurs when the antigens on the RBCs of the donor blood react with the antibodies present in the recipient’s plasma. A cancer sufferer who has been placed on the transplant waiting list wants her story to raise awareness of the importance of carrying a donor card. The mechanism of HCV infection leads to liver cancer remains unclear. Evaluation, management and treatment of patients with chronic inflammation of the liver is an important task for the clinician. Also, linked treatment data were not available for this study, which eliminated the possibility of examining the extent to which antiviral therapy reduces HCC risk; however, this might form the basis of future studies when additional data permit. Although some previously-reported risk factors were not significant in our analysis, those that were identified were largely consistent with studies conducted in other regions of the world. Co-infection with HBV and HCV was associated with increased HCC risk in the HCV cohort, and of all risk factors considered, cirrhosis conferred the greatest additional risk, regardless of infection type. After adjustment, metformin use was associated with significant protection (hazard ratio, 0.49). This was also true of thiazolidinediones (hazard ratio, 0.56). Taking insulin, sulfonylureas, and other agents also reduced the risk, but not significantly.
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