Original articlePancreas, biliary tract, and liverEffect of Nucleos(t)ide Analogue Therapy on Risk of Intrahepatic Cholangiocarcinoma in Patients With Chronic Hepatitis B
Section snippets
Study Design
In this retrospective nationwide cohort study, we retrieved medical records from Taiwan’s National Health Insurance Research Database (NHIRD) between October 1, 2003 and December 31, 2012. The NHIRD contains healthcare data from more than 99% of Taiwan’s entire population of 23.38 million.20 As outlined in our previous studies,19, 21, 22 the NHIRD database comprises comprehensive medical data, and diseases are defined according to the International Classification of Diseases, 9th Revision
Study Subjects
As presented in Figure 1, we screened 185,843 patients who had been diagnosed with chronic hepatitis B between October 1, 2003 and December 31, 2012, and 80,641 patients who used NAs or hepatoprotectants for at least 90 days were identified. After excluding patients with potential confounding factors, 51,707 patients were selected. Furthermore, patients in the NA-treated cohort were matched with patients in the untreated cohort, and a total of 10,062 patients in the treated group and 10,062 in
Discussion
Although HBV infection has been shown to be a major risk factor for ICC development,16, 17 the protective effect of NA therapy via directly inhibiting HBV replication is poorly understood. This large cohort study demonstrated that ICC development rates were significantly lower in the NA-treated group compared with rates in the untreated group, and NA therapy was an independent risk factor associated with reduced risk of ICC development. This study reports a positive effect of NA therapy on the
References (30)
- et al.
Descriptive epidemiology of cholangiocarcinoma in Italy
Dig Liver Dis
(2010) - et al.
Cholangiocarcinoma: current opinion on clinical practice diagnostic and therapeutic algorithms—a review of the literature and a long-standing experience of a referral center
Dig Liver Dis
(2016) - et al.
Cholangiocarcinoma: update and future perspectives
Dig Liver Dis
(2010) - et al.
Demonstration of duck hepatitis B virus in bile duct epithelial cells: implications for pathogenesis and persistent infection
Hepatology
(1997) - et al.
Are common factors involved in the pathogenesis of primary liver cancers? a meta-analysis of risk factors for intrahepatic cholangiocarcinoma
J Hepatol
(2012) - et al.
Expression of HBx protein in hepatitis B virus-infected intrahepatic cholangiocarcinoma
Hepatobiliary Pancreat Dis Int
(2012) - et al.
Global cancer statistics, 2012
CA Cancer J Clin
(2015) - et al.
Epidemiology of cholangiocarcinoma: an update focusing on risk factors
Cancer Sci
(2010) - et al.
Biliary tract cancers in Olmsted County, Minnesota, 1976-2008
Am J Gastroenterol
(2012) - et al.
Trends in the incidence of primary liver and biliary tract cancers in England and Wales 1971-2001
Br J Cancer
(2006)
Increasing incidence of cholangiocarcinoma in Crete 1992-2000
Anticancer Res
A comparison of trends in the incidence of hepatocellular carcinoma and intrahepatic cholangiocarcinoma in the United States
Cancer Epidemiol Biomarkers Prev
A nationwide population-based study shows increasing incidence of cholangiocarcinoma
Hepatol Int
Cholangiocarcinoma: advances in pathogenesis, diagnosis, and treatment
Hepatology
Effect of nucleoside analogue therapy on duck hepatitis B viral replication in hepatocytes and bile duct epithelial cells in vivo
J Gastroenterol Hepatol
Cited by (17)
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2021, Clinical Gastroenterology and HepatologySurgical management of biliary malignancy
2021, Current Problems in SurgeryCitation Excerpt :Another retrospective study using Taiwan's National Health Insurance Research Database compared 10,062 patients with HBV who received treatment to 10,062 propensity-matched controls who did not receive treatment for their HBV. The cumulative incidence of IHCC was significantly higher in patients with untreated HBV than those who received treatment (4.32%, 95%CI 2.96-5.68 vs 1.53%, 95%CI 0.73-2.33; P = 0.005), suggesting that uncontrolled HBV infection may contribute to the development of IHCC.24 Infection with the liver flukes Clonorchis sinensis and Opisthorchis viverrini, foodborne trematode parasites that chronically infect the bile ducts, is a significant risk factor for the development of IHCC.22
Issue Highlights
2020, Clinical Gastroenterology and Hepatology
This article has an accompanying continuing medical education activity, also eligible for MOC credit, on page e71. Learning Objective–Upon completion of this activity, successful learners will be able to identify the high-risk patients for antiviral therapy to prevent hepatitis B virus-related liver cancer.
Conflicts of interest The authors disclose no conflicts.
Funding Supported in part by the National Health Research Institutes (CA-106-PP-37) and the Taichung Veterans General Hospital (106DHA0500150), Taiwan.