By
Liz Highleyman
Eric
Engels from the U.S. National Cancer Institute and colleagues
from South Korea performed a study to assess whether chronic
hepatitis B increased the risk of subsequent development
of NHL among patients in South Korea. HBV prevalence has historically
been high in Korea -- as it is throughout Asia -- though lower
today due to successful vaccination campaigns.
The
researchers looked at participants in the Korean Cancer Prevention
Study, a cohort of South Korean workers and their dependants
enrolled during 1992-1995. They excluded individuals who died
before January 1, 1993, those who had cancer at or before
the initial study visit, those with a history of heavy alcohol
use, people with HIV
or hepatitis C virus (HCV)
coinfection, and those missing information about height, weight,
or alanine aminotransferase (ALT) or aspartate aminotransferase
(AST) levels.
Out
of 1,284,586 eligible participants, a total of 603,585 had
available baseline data on hepatitis B surface antigen (HBsAg)
status and were included in the analysis. People who tested
positive for HBsAg at baseline were considered to have chronic
HBV infection.
Follow-up
continued for up to 14 years, through December 31, 2006. The
study authors used national databases of inpatient and outpatient
diagnoses and death records to determine occurrence of blood-related
malignancies. They assessed the incidence (new cases) of NHL
overall and of NHL subtypes, malignant immunoproliferation,
Hodgkin's lymphoma, multiple myeloma, and various types of
leukemia.
Results
 |
Out
of the 603,585 eligible participants, 53,045 (8.8%) tested
HBsAg positive at baseline. |
|
Subsequently,
133 HBsAg positive participants and 905 HBsAg negative
individuals developed NHL, for incidence rates of 19.4
vs 12.3 per 100,000 person-years, respectively. |
|
HBsAg
positive participants had an increased risk of NHL overall
compared with HBsAg negative people after adjusting for
sex, age, and year of study enrollment (adjusted hazard
ratio [HR] 1.74, or nearly twice the risk). |
|
Looking
at NHL subtypes, HBsAg positivity was associated with
increased risk of diffuse large B-cell lymphoma (325 cases,
incidence rates 6.9 vs 3.8 per 100,000 person-years; adjusted
HR 2.01), as well as malignancies of unknown subtype. |
|
HBsAg
positive participants also had an increased risk of malignant
immunoproliferation (14 cases, incidence rates 0.4 vs
0.2 per 100,000 person-years; adjusted HR 3.79). |
|
Risk
for these malignancies was consistently higher among HBsAg
positive participants throughout 14 years of follow-up. |
|
Being
HBsAg positive was not, however, associated with follicular
or T-cell NHL, Hodgkin's lymphoma, multiple myeloma, or
various leukemias. |
Based
on these findings, the study authors concluded, "During
extended follow-up, HBsAg positive individuals had an increased
risk of NHL, suggesting that chronic HBV infection promotes
lymphomagenesis."
Division
of Cancer Epidemiology and Genetics, National Cancer Institute,
Rockville, MD; Institute of Human Genomic Study, College of
Medicine, Korea University, Seoul, South Korea; Department
of Epidemiology, Institute for Health Promotion, Graduate
School of Public Health, Yonsei University, Seoul, South Korea
8/6/10
Reference
EA
Engels, ER Cho, and SH Jee. Hepatitis B virus infection and
risk of non-Hodgkin lymphoma in South Korea: a cohort study.
Lancet Oncology (Abstract).
August 4, 2010 (Epub ahead of print).
