Research on chronic HBV infection and risk factors in patients with liver cancer in the hospital of Hue college of medicine and pharmacy

JOURNAL OF SCIENCE, Hue University, N0 61, 2010<br /> <br /> RESEARCH ON CHRONIC HBV INFECTION AND<br /> RISK FACTORS IN PATIENTS WITH LIVER CANCER IN<br /> THE HOSPITAL OF HUE COLLEGE OF MEDICINE AND PHARMACY<br /> Vo Dang Anh Thu, Nguyen Thi Kim Hoa, Pham Van Linh<br /> College of Medicine and Pharmacy, Hue University<br /> <br /> SUMMARY<br /> Research on the risk factors of liver cancer, particularly HBV infection is necessary for<br /> preventing liver cancer and to reduce the prevalence of this cancer in future. Objectives: To<br /> identify the risk factors among patients with liver cancer in Hue college of Medicine and<br /> Pharmacy. Methods: A case-control study was conducted from May 2007 to May 2008 in which<br /> there were 40 patients with liver cancer and 40 people without any liver diseases. For each<br /> patient, there was a person in the control group has the same age, gender and living areas.<br /> Results: (1) The average age of the study subjects was 53.7±8.9 in which age 54.3±12.1 was the<br /> mean for men and age 52.9±8.9 for women, 50% of liver cancer patients aged from 45 to 60.<br /> The ratio of men to women was 3 to 1. (2) The risk factors of liver cancer include: HBsAg (+)<br /> (OR = 17.0), history of alcohol consumption (OR=7.0), drinking frequency (OR=4.5), the<br /> volume of alcohol intake (OR=5.18), tobacco consumption (OR = 2.51), familial history of liver<br /> cancer (OR = 5.52). (3) The exposure to organic pesticides is not associated with liver cancer<br /> (OR=1.48, p>0.05, χ2= 0.39). Conclusion: This research was useful in identifying risk factors<br /> of liver cancer. The results from this research will be used to inform the community and future<br /> study of the risk factors of liver cancer.<br /> <br /> 1. Introduction<br /> Liver cancer is one of the most common cancers worldwide. This is the fifth<br /> most common cause of cancer in men and the eighth most common cause in women. In<br /> Vietnam, liver cancer is also a common and serious cancer that affects men more often<br /> than women, and which was ranked the third most common cancer in men and the sixth<br /> in women. As in many Asian countries, Vietnam is one of the countries that have a high<br /> prevalence of liver cancer due to the high proportion of hepatitis B and C infection.<br /> Major risk factors of hepatocellular carcinoma are hepatitis B and C. Thereto,<br /> alcohol and cirrhosis also largely contribute to the causes of this serious cancer. One<br /> study has shown that alcoholics were two times more likely than non-alcoholics to<br /> develop liver cancer, and twenty-two times more likely to develop liver cancer if there<br /> 459<br /> <br /> was cirrhosis induced by alcohol. Meanwhile, aflatoxin B1 is the main causal factor of<br /> live cancer due to chemicals. Research on risk factors of liver cancer, particularly HBV<br /> infection are necessary for preventing liver cancer and contributing to the reduction in<br /> the prevalence of this cancer in the future. This study was conducted in order to<br /> determine the relationship between chronic hepatitis B virus infection and other risk<br /> factors among patients with liver cancer.<br /> 2. Methodology<br /> A case-control study was done from May 2007 to May 2008.<br /> 2.1. Sample<br /> Using the formula of Schlesselman3:<br /> <br /> Z<br /> n<br /> u<br /> <br /> α<br /> <br /> 2u 1  u   Zβ f 1  f   p 3q 3<br /> <br /> <br /> <br /> 2<br /> <br /> f  p 3 2<br /> <br /> fOR<br />  p <br /> 1 <br /> OR<br /> f 1 <br /> 3<br /> 1  f OR  1<br /> 2  1  f OR  1 <br /> <br /> q 3  1  p3<br /> <br /> Predicted: f = 0.35; OR = 3.5; accepted:  = 0.05;  = 0.2; → n  40<br /> 2.2. Selection of cases and controls<br /> The cases were 40 patients with liver cancer who were under treatment at the<br /> hospital of Hue college of Medicine and Pharmacy. Under the principle of the same<br /> living area, sex and age, 40 non-liver cancer subjects were selected as controls.<br /> Consequently, the study subjects include 40 cases and 40 controls.<br /> 2.3. Contents of the study<br /> The study contents composed of three parts as follow: (1).General<br /> characteristics; (2). Personal habits: including alcohol consumption and cigarette<br /> smoking; (3). Symptoms and disease history related with liver cancer.<br /> 2.4. Investigation methods<br /> the constructed questionnaire was used to collect data. All interviewers were<br /> trained focusing on the skills of interviewing the subjects. No subjects refused to be<br /> interviewed.<br /> 2.5. Statistical analysis<br /> Classical analysis methods of case-control study was used to analyze data. OR<br /> value and χ2 were calculated. In this study, the EPI INFO 6.04 was used for completing<br /> all the statistical analyses.<br /> <br /> 460<br /> <br /> 3. Results<br /> Table 1. Age<br /> <br /> Age<br /> <br /> Frequency<br /> <br /> %<br /> <br /> 15 - 30<br /> <br /> 0<br /> <br /> 0<br /> <br /> > 30 - 45<br /> <br /> 10<br /> <br /> 25<br /> <br /> > 45 - 60<br /> <br /> 20<br /> <br /> 50<br /> <br /> > 60<br /> <br /> 10<br /> <br /> 25<br /> <br /> Sum<br /> <br /> 40<br /> <br /> 100<br /> <br /> *There was 50% liver cancer patients aged 45-60.<br /> Table 2. Sex<br /> <br /> Sex<br /> <br /> Frequency<br /> <br /> %<br /> <br /> Male<br /> <br /> 30<br /> <br /> 75.0<br /> <br /> Female<br /> <br /> 10<br /> <br /> 25.0<br /> <br /> Sum<br /> <br /> 40<br /> <br /> 100<br /> <br /> *Men have higher proportion of liver cancer than women; the ratio of men to<br /> women is three to one.<br /> Table 3. The situation of hepatitis B infection among patients with liver cancer<br /> <br /> Cases<br /> HBsAg<br /> n<br /> <br /> %<br /> <br /> (+)<br /> <br /> 30<br /> <br /> 75.0<br /> <br /> (-)<br /> <br /> 10<br /> <br /> 25.0<br /> <br /> Sum<br /> <br /> 40<br /> <br /> 100<br /> <br /> *75% patients with liver cancer have HBsAg (+)<br /> Table 4. The relation between hepatitis B infection and liver cancer<br /> <br /> Cases<br /> <br /> Controls<br /> <br /> HBsAg(+)<br /> <br /> 30<br /> <br /> 6<br /> <br /> 36<br /> <br /> HBsAg(-)<br /> <br /> 10<br /> <br /> 34<br /> <br /> 44<br /> <br /> 40<br /> <br /> 40<br /> <br /> 80<br /> <br /> 461<br /> <br /> OR = 17.0<br /> 95%CI of OR = (4.91 – 62.64)<br /> χ2 = 29.1<br /> p < 0.001<br /> Table 5. The relation between contracting hepatitis B in history and liver cancer<br /> <br /> Cases<br /> <br /> Controls<br /> <br /> Yes<br /> <br /> 14<br /> <br /> 3<br /> <br /> 17<br /> <br /> No<br /> <br /> 26<br /> <br /> 37<br /> <br /> 63<br /> <br /> 40<br /> <br /> 40<br /> <br /> 80<br /> <br /> OR = 6.64<br /> 95%CI of OR = (1.55 – 32.62)<br /> χ2 = 9.04<br /> p < 0.01<br /> Table 6. The relation between history of alcohol consumption and liver cancer<br /> <br /> Cases<br /> <br /> Controls<br /> <br /> Yes<br /> <br /> 30<br /> <br /> 12<br /> <br /> 42<br /> <br /> No<br /> <br /> 10<br /> <br /> 28<br /> <br /> 38<br /> <br /> 40<br /> <br /> 40<br /> <br /> 80<br /> <br /> OR = 7.00<br /> 95%CI of OR = (2.36 – 21.39)<br /> χ2 = 16.24<br /> p < 0.001<br /> Table 7. The relation between alcohol drinking frequency and liver cancer<br /> <br /> Cases<br /> <br /> Controls<br /> <br /> Frequent<br /> <br /> 18<br /> <br /> 3<br /> <br /> 21<br /> <br /> No frequent<br /> <br /> 12<br /> <br /> 9<br /> <br /> 21<br /> <br /> 30<br /> <br /> 12<br /> <br /> 42<br /> <br /> OR = 4.50<br /> 95%CI of OR = (0.84 – 26.75)<br /> 462<br /> <br /> χ2 = 4.20<br /> p < 0.05<br /> Table 8. The relation between the daily volume of alcohol intake and liver cancer<br /> <br /> Cases<br /> <br /> Controls<br /> <br /> ≥ 30 gammes<br /> <br /> 19<br /> <br /> 3<br /> <br /> 22<br /> <br /> < 30 gammes<br /> <br /> 11<br /> <br /> 9<br /> <br /> 20<br /> <br /> 30<br /> <br /> 12<br /> <br /> 42<br /> <br /> OR = 5.18<br /> 95%CI of OR = (0.96 – 31.12)<br /> χ2 = 5.05<br /> p < 0.05<br /> Table 9. The relation between history of exposure to chemicals and liver cancer<br /> <br /> Cases<br /> <br /> Controls<br /> <br /> Yes<br /> <br /> 7<br /> <br /> 5<br /> <br /> 12<br /> <br /> No<br /> <br /> 33<br /> <br /> 35<br /> <br /> 68<br /> <br /> 40<br /> <br /> 40<br /> <br /> 80<br /> <br /> OR = 1.48<br /> 95%CI of OR = (0.37 – 6.09)<br /> χ2 = 0.39<br /> p > 0.05<br /> Table 10. The relation between history of tobacco smoking and liver cancer<br /> <br /> Cases<br /> <br /> Controls<br /> <br /> Smoking<br /> <br /> 26<br /> <br /> 17<br /> <br /> 43<br /> <br /> Non-smoking<br /> <br /> 14<br /> <br /> 23<br /> <br /> 37<br /> <br /> 40<br /> <br /> 40<br /> <br /> 80<br /> <br /> OR = 2.51<br /> 95%CI of OR = (0.93 – 6.88)<br /> χ2 = 4.07<br /> p < 0.05<br /> 463<br /> <br />