Hepatitis B virus may be linked to gastric cancer

Reuters Health Information: Hepatitis B virus may be linked to gastric cancer

Hepatitis B virus may be linked to gastric cancer

Last Updated: 2015-02-26

By Will Boggs MD

NEW YORK (Reuters Health) - Hepatitis B virus (HBV) infection is associated with gastric cancer, particularly in patients without a family history of gastric cancer, researchers from China report.

Chronic HBV infection can lead to liver cirrhosis, and patients with liver cirrhosis have a high prevalence of gastric ulcers and an increased risk of gastric cancer.

Dr. Ruihua Xu from Sun Yat-sen University Cancer Center, Guangzhou, and colleagues speculated that HBV infection could play a role in the risk of gastric cancer in China, so they launched a retrospective case-control study to investigate the possible association.

The prevalence of hepatitis B surface antigen (HBsAg) positivity was significantly higher among gastric cancer cases (17.2%) than among controls (12.1%), whereas the prevalence of antibodies to HBs was significantly lower among cases (56.4%) than among controls (62.8%), according to the February 19 British Journal of Cancer online report.

Cases and controls did not differ in the prevalences of HBeAg, anti-HBe, and anti-HBc.

In regression analysis adjusted for family history of gastric cancer and history of chronic gastritis, HBsAg remained significantly associated with the risk of gastric cancer.

In subgroup analyses, however, HBsAg was significantly related to gastric cancer risk only in those without a family history of gastric cancer.

"Gastric cancer was found to be associated with a significantly higher rate of positive HBsAg, indicating HBV infection may be a possible risk factor for gastric cancer," the researchers conclude. "Future studies need to verify the existence of HBV DNA and antigens in gastric cancer, and large-scale prospective investigations are warranted to testify the conclusions, and the mechanisms need to be more specifically and thoroughly investigated."

Based on the literature from Chinese database, "the prevalence of HBV DNA in gastric cancer tissues is only 0-3% by PCR test," Dr. Sin-Zu Chen, from West China Hospital, Sichuan University, Chengdu, told Reuters Health by email. "Therefore, to evidence the causality between HBV infection and gastric cancer risk, a qualified study with adequate statistical power requires a dramatically larger scale of sample size than study."

"The studied population is also collected from an endemic region (Guangzhou Province) of both Helicobacter pylori and Epstein-Barr virus infection in mainland China," Dr. Chen said. "Therefore, the results are unable to rule out the confounding effects from these two kinds of infections."

Dr. Chen concluded, "The epidemiological study provides some information about the potential association between HBV infection and gastric cancer risk, but the obvious defect in covariate modeling makes the results still far from health policy and clinical practice. Despite that, the interesting findings also suggest further investigations with large-scale and well-constructed models to rule out potential biases."

Dr. Khean Lee Goh from University of Malaya Medical Center, Kuala Lumpur, Malaysia told Reuters Health that the study's design is weak, and it is "not very clear how representative of the population the controls are. This is a crucial part of the study design."

His take on the study: "This paper was accepted because it is potentially 'news breaking' and will sell," Dr. Goh concluded. "I don't believe there is any causal relationship. Odds ratios and confidence intervals are not strong."

Dr. Xu did not respond to a request for comments.

Several Chinese agencies supported this study. The authors report no disclosures.

SOURCE: http://bit.ly/1ETvTwU

Br J Cancer 2015.

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