Hepatitis B virus infection and risk of non-Hodgkin lymphoma in South Korea: a cohort study
Original Text
Eric A Engels MD a, Eo Rin Cho PhD b, Prof Sun Ha Jee PhD c
Summary
Background
Hepatitis B virus (HBV) infection is common throughout Asia and Africa. Whether chronic HBV infection increases risk of non-Hodgkin lymphoma (NHL) is unclear. We aimed to assess the association between chronic HBV infection and subsequent development of NHL in a South Korean cohort.
Methods
The Korean Cancer Prevention Study is a cohort study of South Korean workers and their dependants enrolled during 1992—95. From this cohort, we excluded individuals who died before Jan 1, 1993, who had cancer at or before the initial visit, who had missing information about weight, height, alanine aminotransferase or aspartate aminotransferase concentrations, or alcohol use, or who had evidence of HIV or HCV infection. Of [1.284.586] eligible participants, 603 585 had baseline data for serum hepatitis B surface antigen (HBsAg) status and were included in our study. We regarded HBsAg positivity at baseline as evidence of chronic HBV infection. Participants were followed up from baseline until Dec 31, 2006. We used national databases of inpatient and outpatient diagnoses and mortality records to ascertain occurrence of haematological malignancies. We assessed incidence of NHL overall and of NHL subtypes, malignant immunoproliferation, Hodgkin's lymphoma, multiple myeloma, and various leukaemias. We used Cox regression to evaluate associations with HBsAg status, adjusting for sex, age, and enrolment year.
Findings
53 045 (9%) of 603 585 participants tested positive for HBsAg at baseline. Subsequently, 133 HBsAg-positive and 905 HBsAg-negative individuals developed NHL. HBsAg-positive participants had an increased risk of NHL overall compared with those who were HBsAg-negative (incidence 19·4 vs 12·3 per 100 000 person-years; hazard ratio [HR] 1·74, 95% CI 1·45—2·09, adjusted for sex, age at baseline, and enrolment year). Among NHL subtypes, HBsAg positivity was associated with increased risk of diffuse large B-cell lymphoma (n=325, incidence 6·86 vs 3·79 per 100 000 person-years; adjusted HR 2·01, 1·48—2·75) and other or unknown subtypes (n=591, incidence 10·5 vs 7·07 per 100 000 person-years; adjusted HR 1·65, 1·29—2·11), compared with HBsAg negativity. Increased risk was also recorded for malignant immunoproliferation (n=14, incidence 0·44 vs 0·15 per 100 000 person-years; adjusted HR 3·79, 1·05—13·7). Risk of these malignancies was consistently raised in HBsAg-positive participants throughout 14 years of follow-up. HBsAg positivity was not associated with follicular or T-cell NHL, Hodgkin's lymphoma, multiple myeloma, or various leukaemias.
Interpretation
During extended follow-up, HBsAg-positive individuals had an increased risk of NHL, suggesting that chronic HBV infection promotes lymphomagenesis.
Funding
Korean Seoul City Research and the National Research and Development Program for Cancer Control, Ministry for Health, Welfare and Family Affairs, Republic of Korea; US National Cancer Institute.
Hepatitis B virus infection and risk of non-Hodgkin lymphoma in South Korea: a cohort study : The Lancet Oncology
EPIDEMIOLOGÍA
Actualidad Ultimas noticias - JANOes -
La hepatitis B duplica el riesgo de desarrollar un linfoma no-Hodgkin
JANO.es · 09 Agosto 2010 11:55
Un artículo aparecido en “The Lancet Oncology” muestra la mayor incidencia de este tipo de cáncer entre los infectados por el virus de la hepatitis B
Las personas infectadas con el virus de la hepatitis B son casi dos veces más propensas a desarrollar un linfoma no-Hodgkin, según ha determinado un estudio del Instituto Nacional de Cáncer y de la Universidad de Yonsei en Seúl, publicado en The Lancet Oncology.
Según explican los autores, anteriormente se sabía que la hepatitis B puede ser la causa de desarrollar un cáncer hepático y, además, algunos científicos ya sospechaban que también podía provocar linfoma.
Los expertos han indicado que este cáncer no es común y que la vacunación masiva contra el virus de la hepatitis B no afectaría a las tasas de linfoma no-Hodgkin. Asimismo han señalado que, no obstante, el tratamiento de la hepatitis B puede ayudar a los pacientes con linfoma.
El estudio afirma que tanto la hepatitis B como la C podrían causar linfoma al estimular en exceso el sistema inmunitario, que intenta combatir la infección hepática.
En la investigación, dirigida por los Dres. Eric Engels y Sun Ha Jee, se analizaron registros de más de 600.000 personas de Corea del Sur, donde la hepatitis B era extremadamente común antes de que comenzara la campaña de vacunación en 1995.
Del total, unos 53.000 pacientes, alrededor del 9%, presentaban evidencia de infección por hepatitis B. Después de 14 años, las tasas de linfoma no-Hodgkin eran más frecuentes entre las personas infectadas: 19,4 frente a 12,3 casos por cada 100.000 personas entre los pacientes sin el virus.
Lancet Oncology 2010;doi:10.1016/S1470-2045(10)70167-4
http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(10)70167-4/abstract
Lancet Oncology
http://www.thelancet.com/journals/lanonc/issue/current
National Cancer Institute
http://www.cancer.gov/
Yonsei University
http://www.yonsei.ac.kr/eng/
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