Alcohol drinking ups liver cancer risk among CHB patients

Patients with chronic hepatitis B (CHB) infection who consume high levels of alcohol are at increased risk of hepatocellular carcinoma (HCC), as suggested in a retrospective study from China.

The study included 1,010 patients (median age 46 years, 81.1 percent male, 51.3 percent had cirrhosis) with persistent HBsAg positivity for at least 6 months. Alcohol consumption was assessed and categorized as follows: low (0–140 g/week for females, 0–210 g/week for males), moderate (140–350 g/week for females, 210–420 g/week for males), and high (>350 g/week for females, >420 g/week for males). High intake corresponded to alcohol-related liver disease (ALD).

Of the patients, 74.3 percent, 16.8 percent, and 8.9 percent had low, moderate, and high alcohol consumption levels, respectively. HCC occurred in 129 patients (12.8 percent) during 3,684 person-years of follow-up. Compared with patients without HCC, those who had HCC had higher alcohol intake levels (200 vs 0 g/wk; p<0.001).

In multivariable Cox regression models, each 100-g/week increase in alcohol intake was associated with a 33-percent increase in HCC risk (adjusted hazard ratio [aHR], 1.33, 95 percent confidence interval [CI], 1.21–1.46; p<0.001). A risk increase was also observed with high vs low-to-moderate consumption levels (aHR, 3.48, 95 percent CI, 2.21–5.48; p<0.001).

Similar associations were observed regardless of cirrhosis status. In the subgroup of patients with cirrhosis, HCC risk significantly increased with each 100-g/week increase in alcohol intake (aHR, 1.32, 95 percent CI, 1.18–1.47; p<0.001) and with high vs low-to-moderate consumption levels (aHR, 3.23, 95 percent CI, 1.83–5.74; p<0.001). In the noncirrhotic subgroup, the corresponding aHRs were 1.44 (95 percent CI, 1.17–1.76; p<0.001) and 4.97 (95 percent CI, 2.11–11.69; p<0.001).

The results were also consistent across subgroups defined by age, HBeAg status, HBV DNA level, age-male-albumin-bilirubin-platelets score, and modified PAGE-B score.

The findings underscore the importance of systematic assessment and control of alcohol intake to mitigate the risk of HCC risk in CHB patients.