The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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Risk Factors of Cryptogenic Hepatocellular Carcinoma in Patients with Low Body Mass Index or without Metabolic Syndrome

  • Song, Hwa-Young (Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine) ;
  • Lee, Hyo-Keun (Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine) ;
  • Lee, June-Sung (Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine) ;
  • Kim, Jong-Yeon (Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine) ;
  • Yim, Yun-Hyuk (Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine) ;
  • Song, Tae-Jun (Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine) ;
  • Bae, Won-Ki (Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine) ;
  • Kim, Nam-Hoon (Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine) ;
  • Kim, Kyung-Ah (Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine)
  • Published : 2012.03.01
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Abstract

Background/Aims: Many patients are diagnosed with cryptogenic hepatocellular carcinoma (HCC) without metabolic syndrome (MS). We investigated the risk factors for cryptogenic HCC in patients with a low body mass index (BMI) or without MS. Methods: Thirty-six patients were diagnosed with cryptogenic HCC over a 10-year period at a tertiary research hospital. Data including BMI score and risk factors for MS were analyzed retrospectively. Patients with fewer than two risk factors for MS (n = 16) were compared with those with two or more risk factors (n = 20). Patients with high BMI (${\geq}\;23\;kg/m^2$, n = 20) were also compared with those with lower BMI (n = 16). Results: Patients with fewer than two risk factors for MS were significantly more likely to smoke and be hepatitis B surface antibodies (anti-HBs)-positive vs. patients with two or more risk factors. However, only smoking was statistically significant on multivariate analysis. Peaks of BMI were observed in two regions. Lower BMI was significantly associated with the presence of anti-HBs compared with high BMI, although this association was not statistically significant on multivariate analysis. Conclusions: Smoking is a potential risk factor for cryptogenic HCC in patients without MS. Remote hepatitis B virus infection may be a risk factor for cryptogenic HCC in patients without MS or with a low BMI.

Keywords

References

  1. Oh KC, Park SH, Park JC, et al. Is the prevalence of cryptogenic hepatocellular carcinoma increasing in Korea? Korean J Gastroenterol 2005;45:45-51.
  2. Nam SW, Jung JJ, Bae SH, et al. Clinical outcomes of delayed clearance of serum HBsAG in patients with chronic HBV infection. Korean J Intern Med 2007;22:73-76. https://doi.org/10.3904/kjim.2007.22.2.73
  3. Bugianesi E, Leone N, Vanni E, et al. Expanding the natural history of nonalcoholic steatohepatitis: from cryptogenic cirrhosis to hepatocellular carcinoma. Gastroenterology 2002;123:134-140. https://doi.org/10.1053/gast.2002.34168
  4. Marrero JA, Fontana RJ, Su GL, Conjeevaram HS, Emick DM, Lok AS. NAFLD may be a common underlying liver disease in patients with hepatocellular carcinoma in the United States. Hepatology 2002;36:1349-1354. https://doi.org/10.1002/hep.1840360609
  5. Starley BQ, Calcagno CJ, Harrison SA. Nonalcoholic fatty liver disease and hepatocellular carcinoma: a weighty connection. Hepatology 2010;51:1820-1832. https://doi.org/10.1002/hep.23594
  6. Siegel AB, Zhu AX. Metabolic syndrome and hepatocellular carcinoma: two growing epidemics with a potential link. Cancer 2009;115:5651-5661. https://doi.org/10.1002/cncr.24687
  7. Page JM, Harrison SA. NASH and HCC. Clin Liver Dis 2009;13:631-647. https://doi.org/10.1016/j.cld.2009.07.007
  8. Paradis V, Zalinski S, Chelbi E, et al. Hepatocellular carcinomas in patients with metabolic syndrome often develop without significant liver fibrosis: a pathological analysis. Hepatology 2009;49:851-859. https://doi.org/10.1002/hep.22734
  9. Park KS, Lee YS, Park HW, et al. Factors associated or related to with pathological severity of nonalcoholic fatty liver disease. Korean J Intern Med 2004;19:19-26. https://doi.org/10.3904/kjim.2004.19.1.19
  10. Kojima H, Sakurai S, Matsumura M, et al. Cryptogenic cirrhosis in the region where obesity is not prevalent. World J Gastroenterol 2006;12:2080-2085. https://doi.org/10.3748/wjg.v12.i13.2080
  11. Korean Liver Cancer Study Group; National Cancer Center, Korea. Practice guidelines for management of hepatocellular carcinoma 2009. Korean J Hepatol 2009;15:391-423. https://doi.org/10.3350/kjhep.2009.15.3.391
  12. Neuschwander-Tetri BA, Caldwell SH. Nonalcoholic steatohepatitis: summary of an AASLD Single Topic Conference. Hepatology 2003;37:1202-1219. https://doi.org/10.1053/jhep.2003.50193
  13. Jimba S, Nakagami T, Takahashi M, et al. Prevalence of non-alcoholic fatty liver disease and its association with impaired glucose metabolism in Japanese adults. Diabet Med 2005;22:1141-1145. https://doi.org/10.1111/j.1464-5491.2005.01582.x
  14. Alberti KG, Zimmet P, Shaw J. Metabolic syndrome-a new world-wide definition: a Consensus Statement from the International Diabetes Federation. Diabet Med 2006;23:469-480. https://doi.org/10.1111/j.1464-5491.2006.01858.x
  15. Marrero JA, Fontana RJ, Fu S, Conjeevaram HS, Su GL, Lok AS. Alcohol, tobacco and obesity are synergistic risk factors for hepatocellular carcinoma. J Hepatol 2005;42:218-224.
  16. WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 2004;363:157-163. https://doi.org/10.1016/S0140-6736(03)15268-3
  17. El-Serag HB. Hepatocellular carcinoma: an epidemiologic view. J Clin Gastroenterol 2002;35(5 Suppl 2):S72-S78. https://doi.org/10.1097/00004836-200211002-00002
  18. Lee HS, Lee JH, Choi MS, Kim CY. Comparison of the incidence of hepatocellular carcinoma in HBV-and HCV-associated liver cirrhosis: a prospective study. Korean J Hepatol 1996;2:21-28.
  19. Mori M, Hara M, Wada I, et al. Prospective study of hepatitis B and C viral infections, cigarette smoking, alcohol consumption, and other factors associated with hepatocellular carcinoma risk in Japan. Am J Epidemiol 2000;151:131-139. https://doi.org/10.1093/oxfordjournals.aje.a010180
  20. Shimada S, Aizawa R, Abe H, Suto S, Miyakawa Y, Aizawa Y. Analysis of risk factors for hepatocellular carcinoma that is negative for hepatitis B surface antigen (HBsAg). Intern Med 2003;42:389-393. https://doi.org/10.2169/internalmedicine.42.389
  21. Bacon BR, Farahvash MJ, Janney CG, Neuschwander-Tetri BA. Nonalcoholic steatohepatitis: an expanded clinical entity. Gastroenterology 1994;107:1103-1109. https://doi.org/10.1016/0016-5085(94)90235-6
  22. Teli MR, James OF, Burt AD, Bennett MK, Day CP. The natural history of nonalcoholic fatty liver: a follow-up study. Hepatology 1995;22:1714-1719. https://doi.org/10.1002/hep.1840220616
  23. Bhala N, Angulo P, van der Poorten D, et al. The natural history of nonalcoholic fatty liver disease with advanced fibrosis or cirrhosis: an international collaborative study. Hepatology 2011;54:1208-1216. https://doi.org/10.1002/hep.24491
  24. Adams LA, Lindor KD. Nonalcoholic fatty liver disease. Ann Epidemiol 2007;17:863-869. https://doi.org/10.1016/j.annepidem.2007.05.013
  25. El-Zayadi AR. Heavy smoking and liver. World J Gastroenterol 2006;12:6098-6101. https://doi.org/10.3748/wjg.v12.i38.6098
  26. El-Zayadi A, Selim O, Hamdy H, et al. Impact of cigarette smoking on response to interferon therapy in chronic hepatitis C Egyptian patients. World J Gastroenterol 2004;10:2963-2966. https://doi.org/10.3748/wjg.v10.i20.2963
  27. Higashi Y, Tada S, Miyase S, et al. Correlation of clinical characteristics with detection of hepatitis B virus X gene in liver tissue in HBsAg-negative, and HCV-negative hepatocellular carcinoma patients. Liver 2002;22:374-379. https://doi.org/10.1034/j.1600-0676.2002.01645.x
  28. Yu MC, Yuan JM, Ross RK, Govindarajan S. Presence of antibodies to the hepatitis B surface antigen is associated with an excess risk for hepatocellular carcinoma among non-Asians in Los Angeles County, California. Hepatology 1997;25:226-228. https://doi.org/10.1002/hep.510250141
  29. Tamori A, Nishiguchi S, Kubo S, et al. HBV DNA integration and HBV-transcript expression in non-B, non-C hepatocellular carcinoma in Japan. J Med Virol 2003;71:492-498. https://doi.org/10.1002/jmv.10514

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