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Abstract：
Hepatitis C virus (HCV) infection causes hepatocellular carcinoma (HCC) and subtypes of non-Hodgkin lymphoma (NHL). Associations with other cancers are not established. The authors systematically assessed associations between HCV infection and cancers in the US elderly population.
This was a registry-based case-control study using Surveillance, Epidemiology, and End Results (SEER)-Medicare data in US adults aged ≥66 years. Cases (n = 1,623,538) were patients who had first cancers identified in SEER registries (1993-2011). Controls (n = 200,000) were randomly selected, cancer-free individuals who were frequency-matched to cases on age, sex, race, and calendar year. Associations with HCV (documented by Medicare claims) were determined using logistic regression.
HCV prevalence was higher in cases than in controls (0.7% vs 0.5%). HCV was positively associated with cancers of the liver (adjusted odds ratio [aOR] = 31.5; 95% confidence interval [CI], 29.0-34.3), intrahepatic bile duct (aOR, 3.40; 95% CI, 2.52-4.58), extrahepatic bile duct (aOR, 1.90; 95% CI, 1.41-2.57), pancreas (aOR, 1.23; 95% CI, 1.09-1.40), and anus (aOR, 1.97; 95% CI, 1.42-2.73); nonmelanoma nonepithelial skin cancer (aOR, 1.53; 95% CI, 1.15-2.04); myelodysplastic syndrome (aOR, 1.56; 95% CI, 1.33-1.83); and diffuse large B-cell lymphoma (aOR, 1.57; 95% CI, 1.34-1.84). Specific skin cancers associated with HCV were Merkel cell carcinoma (aOR, 1.92; 95% CI, 1.30-2.85) and appendageal skin cancers (aOR, 2.02; 95% CI, 1.29-3.16). Inverse associations were observed with uterine cancer (aOR, 0.64; 95% CI, 0.51-0.80) and prostate cancer (aOR, 0.73; 95% CI, 0.66-0.82). Associations were maintained in sensitivity analyses conducted among individuals without documented alcohol abuse, cirrhosis, or hepatitis B or human immunodeficiency virus infections and after adjustment for socioeconomic status. Associations of HCV with other cancers were not observed.
HCV is associated with increased risk of cancers other than HCC in the US elderly population, notably bile duct cancers and diffuse large B-cell lymphoma. These results support a possible etiologic role for HCV in an expanded group of cancers. Cancer 2017;123:1202-1211. © 2016 American Cancer Society.
This was a registry-based case-control study using Surveillance, Epidemiology, and End Results (SEER)-Medicare data in US adults aged ≥66 years. Cases (n = 1,623,538) were patients who had first cancers identified in SEER registries (1993-2011). Controls (n = 200,000) were randomly selected, cancer-free individuals who were frequency-matched to cases on age, sex, race, and calendar year. Associations with HCV (documented by Medicare claims) were determined using logistic regression.
HCV prevalence was higher in cases than in controls (0.7% vs 0.5%). HCV was positively associated with cancers of the liver (adjusted odds ratio [aOR] = 31.5; 95% confidence interval [CI], 29.0-34.3), intrahepatic bile duct (aOR, 3.40; 95% CI, 2.52-4.58), extrahepatic bile duct (aOR, 1.90; 95% CI, 1.41-2.57), pancreas (aOR, 1.23; 95% CI, 1.09-1.40), and anus (aOR, 1.97; 95% CI, 1.42-2.73); nonmelanoma nonepithelial skin cancer (aOR, 1.53; 95% CI, 1.15-2.04); myelodysplastic syndrome (aOR, 1.56; 95% CI, 1.33-1.83); and diffuse large B-cell lymphoma (aOR, 1.57; 95% CI, 1.34-1.84). Specific skin cancers associated with HCV were Merkel cell carcinoma (aOR, 1.92; 95% CI, 1.30-2.85) and appendageal skin cancers (aOR, 2.02; 95% CI, 1.29-3.16). Inverse associations were observed with uterine cancer (aOR, 0.64; 95% CI, 0.51-0.80) and prostate cancer (aOR, 0.73; 95% CI, 0.66-0.82). Associations were maintained in sensitivity analyses conducted among individuals without documented alcohol abuse, cirrhosis, or hepatitis B or human immunodeficiency virus infections and after adjustment for socioeconomic status. Associations of HCV with other cancers were not observed.
HCV is associated with increased risk of cancers other than HCC in the US elderly population, notably bile duct cancers and diffuse large B-cell lymphoma. These results support a possible etiologic role for HCV in an expanded group of cancers. Cancer 2017;123:1202-1211. © 2016 American Cancer Society.
摘要：
丙型肝炎病毒（HCV）感染导致肝细胞癌（HCC）和非霍奇金淋巴瘤（NHL）的亚型。与其他癌症的关系尚未确定。作者系统地评估了美国老年人群HCV感染与癌症之间的关联。
这是一项基于注册的病例对照研究，使用监测，流行病学,和最终结果（SEER）-美国66岁以上成年人的医疗保险数据。病例（n=1,623,538）是SEER注册（1993-2011）中首次发现癌症的患者。随机选择对照（n=200,000），与年龄病例频率匹配的无癌个体，性别,种族,和日历年。使用逻辑回归确定与HCV的关联（由Medicare索赔记录）。
病例的HCV患病率高于对照组（0.7%vs0.5%）。HCV与肝癌呈正相关(调整比值比[aOR]=31.5;95%置信区间[CI],29.0-34.3),肝内胆管（aOR，3.40；95%CI，2.52-4.58)，肝外胆管（aOR，1.90；95%CI，1.41-2.57），胰腺(aOR,1.23；95%CI，1.09-1.40），和肛门（aOR，1.97；95%CI，1.42-2.73)；非黑色素瘤非上皮皮肤癌(aOR，1.53；95%CI，1.15-2.04)；骨髓增生异常综合征(aOR，1.56；95%CI，1.33-1.83)；和弥漫性大B细胞淋巴瘤(aOR，1.57；95%CI，1.34-1.84）。与HCV相关的特定皮肤癌是默克尔细胞癌(aOR，1.92；95%CI，1.30-2.85）和阑尾皮肤癌（aOR，2.02；95%CI，1.29-3.16）。观察到与子宫癌的反向关联(aOR，0.64；95%CI，0.51-0.80）和前列腺癌（aOR，0.73；95%CI，0.66-0.82）。在没有记录在案的酗酒者之间进行的敏感性分析中保持了关联，肝硬化,或乙型肝炎或人类免疫缺陷病毒感染和社会经济地位调整后。未观察到HCV与其他癌症的关联。
在美国老年人群中，HCV与肝癌以外的癌症风险增加有关。尤其是胆管癌和弥漫性大B细胞淋巴瘤。这些结果支持HCV在一组扩展的癌症中可能的病因学作用。癌症2017；123：1202-1211。©2016美国癌症协会。
这是一项基于注册的病例对照研究，使用监测，流行病学,和最终结果（SEER）-美国66岁以上成年人的医疗保险数据。病例（n=1,623,538）是SEER注册（1993-2011）中首次发现癌症的患者。随机选择对照（n=200,000），与年龄病例频率匹配的无癌个体，性别,种族,和日历年。使用逻辑回归确定与HCV的关联（由Medicare索赔记录）。
病例的HCV患病率高于对照组（0.7%vs0.5%）。HCV与肝癌呈正相关(调整比值比[aOR]=31.5;95%置信区间[CI],29.0-34.3),肝内胆管（aOR，3.40；95%CI，2.52-4.58)，肝外胆管（aOR，1.90；95%CI，1.41-2.57），胰腺(aOR,1.23；95%CI，1.09-1.40），和肛门（aOR，1.97；95%CI，1.42-2.73)；非黑色素瘤非上皮皮肤癌(aOR，1.53；95%CI，1.15-2.04)；骨髓增生异常综合征(aOR，1.56；95%CI，1.33-1.83)；和弥漫性大B细胞淋巴瘤(aOR，1.57；95%CI，1.34-1.84）。与HCV相关的特定皮肤癌是默克尔细胞癌(aOR，1.92；95%CI，1.30-2.85）和阑尾皮肤癌（aOR，2.02；95%CI，1.29-3.16）。观察到与子宫癌的反向关联(aOR，0.64；95%CI，0.51-0.80）和前列腺癌（aOR，0.73；95%CI，0.66-0.82）。在没有记录在案的酗酒者之间进行的敏感性分析中保持了关联，肝硬化,或乙型肝炎或人类免疫缺陷病毒感染和社会经济地位调整后。未观察到HCV与其他癌症的关联。
在美国老年人群中，HCV与肝癌以外的癌症风险增加有关。尤其是胆管癌和弥漫性大B细胞淋巴瘤。这些结果支持HCV在一组扩展的癌症中可能的病因学作用。癌症2017；123：1202-1211。©2016美国癌症协会。
