Chronic liver diseases for the risk of hepatocellular carcinoma: a case-control study in Japan. Etiologic association of alcohol consumption, cigarette smoking and the development of chronic liver diseases

Abstract

Background/aims: A great number of hepatocellular carcinoma (HCC) develop from chronic liver disease. Among a total of 23,000 deaths of HCC in 1988 in Japan, 82% had positive antibodies against HBV and/or HCV. In the present study we investigated the etiological factors involved in this process, employing patients with chronic hepatitis as controls.

Methodology: In this study, alcohol consumption and cigarette smoking were investigated in 104 male patients with HCC which developed from chronic liver disease and 104 male controls with chronic liver disease without HCC (one for each case) matched for age.

Results: When compared with non-drinkers and non-smokers, the relative risk (RR) for developing HCC rose to 17.9 among those with both drinking and smoking habits. The risk was greater than for those in whom either habit existed alone. The RR decreased among ex-smokers who were non-drinkers or ex-drinkers, but it was still as high as 9.4. For current smokers, even if they were non- or ex-drinkers, the RR was 15.4.

Conclusions: Drinking and the cigarette smoking were both risk factors, but the existence of synergism between them was also suggested. Therefore, patients with chronic liver disease should be thoroughly counseled to refrain from both drinking and smoking.