Hepatitis C Linked to Increased Risk of Intrahepatic Cholangiocarcinoma
NEW YORK (Reuters Health) Jan 15 - The risk of intrahepatic
cholangiocarcinoma is significantly elevated in patients infected with
hepatitis C virus (HCV), according to a large case-control study of US
The risk of pancreatic cancer also appears to be slightly elevated in
patients with HCV, although this risk was attenuated after adjusting for
alcohol use and other variables, the research team reports in the January
issue of Hepatology.
Previous studies investigating the link between HCV infection and cancers of
the hepatopancreaticobiliary tumors other than hepatocellular carcinoma
tended to be small or subject to bias, note Dr. Hashem B. El-Serag, at the
Houston VA Medical Center, and colleagues there and at the National Cancer
Institute in Rockville, Maryland.
To clarify these issues, Dr. El-Serag's team obtained data for 146,394 HCV-infected
subjects and 572,293 HCV-uninfected subjects for the period between 1988 and
2004. The mean patient age was 52 years old, the mean follow-up was 2.3
years, and most of the patients were men (96.7%).
When comparing HCV-infected with HCV-uninfected subjects, the hazard ratios
for hepatocellular carcinoma, intrahepatic cholangiocarcinoma, and
pancreatic cancer were 15.09, 2.55, and 1.23, respectively. The risk of
extrahepatic cholangiocarcinoma was not significantly elevated, which
according to the authors, supports the theory that intracellular and
extracellular cholangiocarcinoma are distinct malignancies.
Analyses adjusting for other variables, such as alcohol use, pancreatitis,
and cholelithiasis, confirmed the strong association between HCV and
hepatocellular carcinoma and intrahepatic cholangiocarcinoma, the report
indicates. However, the association between HCV and pancreatic cancer was no
longer statistically significant.
"HCV is a strong risk factor for hepatocellular carcinoma and hepatocytes
and cholangiocytes have the same progenitor cell," the authors note. "It
could be postulated the HCV could induce carcinogenesis in both cell types
by the same mechanism."
Finally, Dr. El-Serag and colleagues maintain, the mixed findings of this
study regarding the association between HCV and pancreatic cancer "merit
"From a clinical perspective," they conclude, "early intervention
strategies, including screening HCV-positive individuals earlier or more
rigorously, may improve the outcomes for both hepatocellular carcinoma and