Chronic hepatitis B infection and non-hepatocellular cancers: A hospital registry-based, case-control study

BACKGROUND Prior epidemiological evidences suggest that hepatitis B virus (HBV) infection is linked to cancers other than hepatocellular carcinoma. This prospective hospital registry-based case-control study aimed to investigate the sero-epidemiological association between chronic HBV infection and various types of cancer. METHODS 95,034 patients with first-diagnosed non-hepatocellular malignancy in a tertiary hospital between 2007 and 2014; and 118,891 non-cancer individuals as controls from a health promotion center were included. Cases and controls were compared for HBV surface antigen (HBsAg) positivity by conditional regression with adjustment for age, hypertension, diabetes, body mass index, alcohol consumption, smoking status and cholesterol level in both genders. RESULTS An analysis of matched data indicated significant associations of HBV infection with lymphoma (adjusted odds ratio[AOR] 1.53 [95% CI 1.12-2.09] in men and 3.04 [1.92-4.82] in women) and biliary cancer (2.59[1.98-3.39] in men and 1.71[1.16-2.51] in women). Cervical (1.49[1.11-2.00]), uterine (1.69[1.09-2.61]), breast (1.16[1.02-1.32]), thyroid (1.49[1.28-1.74]), and lung cancers (1.79[1.32-2.44]) in women; and skin cancer (5.33[1.55-18.30]) in men were also significantly related to HBV infection. CONCLUSIONS Chronic HBV infection is associated with several malignant disorders including lymphoma, and biliary, cervical, uterine, breast, thyroid, lung, and skin cancers. Our findings may offer additional insights into the development of these neoplasms and may suggest the need to consider HBV screening in cancer patients and cancer surveillance in HBV-infected subjects.