Hepatitis B And C Virus, Clonorchis

International Journal ol Epidemiology © International Epidemiological Association 1996

Vol. 25, No. 5 Printed in Great Britain

Hepatitis B and C Virus, Clonorchis sinensis for the Risk of Liver Cancer: A Case-Control Study in Pusan, Korea
HAI-RIM SHIN,* CHAE-UN LEE," HYUNG-JONG PARK," SANG-YOUNG SEOL,* JUNG-MYEONG CHUNG,* HA-CHIN CHOI,* YOON-OK AHN* AND TAKAO SHIGEMASTU§ Shin H-R(Department of Preventive Medicine, College of Medicine, Dong-A University, #1 3Ga Dongdaeshin-dong, So-gu Pusan, Korea 602-103), Lee C-U, Park H-J, Seol S-Y, Chung J-M, Choi H-C, Ahn Y-O and Shigemastu T. International Journal ofEpidemiology 1996; 25: 933-940. Background. Liver cancer mortality in Korea is the highest in the world. Hepatitis B and C viruses (HBV, HCV) are known to be the major riskfactors of hepatocellular carcinoma (HCC). Cholangiocarcinoma (CLG) accounts for more than 20% of liver cancer in the Pusan area. In Korea, the different roles of known risk factors in the development of HCC or CLG have not been adequately evaluated. Methods. Case-control studies involved 203 incident HCC cases, 406 controls matched to the HCC cases for age (± 4 years) and sex, and 41 CLG cases (the HCCcontrols were used). They were carried out from August 1990 to August 1993. Results. Relative risk (RR) of HBsAg (87.4; 95% confidence interval [Cl] : 22.2-344.3) and RR of anti-HCV positivity (30.3; 95% Cl : 6.1-150.6) were significant for the risk of HCC after adjustment for potentially confounding factors. In contrast, RR of Clonorchis sinensis in stool (2.7; 95% Cl : 1.1-6.3) and RR of heavydrinking (4.6; 95% Cl : 1.4-15.2) were significant for the risk of CLG. Transfusion history, acupuncture history, and cigarette smoking were not associated with the risk of HCC or CLG. Conclusions. Strong evidence indicated that both HBV and HCV infection were independent risk factors for HCC. In contrast, C. sinensis in stools and heavy drinking were associated with the risk of CLG in Korea.Keywords: hepatocellular carcinoma, cholangiocarcinoma, hepatitis B virus, hepatitis C virus, Clonorchis sinensis

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Liver cancer is one of the most common cancers in Korea and the death rate among Koreans has been reported as one of the highest in the world.' In 1990, the liver cancer death rate in Korea was reported to beas high as 35.4 per 100 000 for males and 12.0 per 100 000 for females.2 The truncated incidence rate of liver cancer for the age group 35-64 years was 74.8 per 100 000 in males and 15.6 per 100 000 in females, which may be the highest in the world.3 Differences in the incidence of liver cancer around the world suggest that the

* Department of Preventive Medicine, College of Medicine, Dong-AUniversity, #1 3Ga Dongdaeshin-dong, So-gu Pusan, Korea 602-103. •* Department of Preventive Medicine, and ' Department of Internal Medicine, College of Medicine, Inje University, Pusan, Korea. * Department of Preventive Medicine, College of Medicine, Seoul National University, Seoul, Korea. 'Department of Public Health, School of Medicine, Fukuoka University, Fukuoka, Japan.

environment may be acrucial factor in the development of this cancer. In the aetiology of primary liver cancer, three major types (hepatocellular carcinoma, cholangiocarcinoma, miscellaneous tumours) may be considered. Hepatocellular carcinoma (HCC) is by far the most common type, and cholangiocarcinoma (CLG) accounts for more than 20% of liver cancer in the Pusan area of Korea.4 Many researchers have suggested thatHCC is multifactorial in origin, with a possible interaction between the hepatitis B and C viruses and other factors such as aflatoxin, alcohol, cirrhosis, tobacco smoking, oral contraceptives, etc.5"20 Cholangiocarcinoma is known to be associated with heavy infestation by Clonorchis sinensis2* and Opisthorchis viverrini.22 Case-control studies were conducted to evaluate the different roles that...