Clinical risk factors for hepatocellular carcinoma in Southeast Louisiana: a matched case-control study.

Abstract

Purpose: Hepatocellular carcinoma (HCC) incidence rates have risen in the past 30 years, and it is vital to understand the risk factors that contribute to the disease. Notably, Louisiana is experiencing higher than average rates of hepatitis C (HCV), obesity, alcohol use disorder (AUD), and poverty which are all possible risk factors for HCC. Thus, the primary objective was to assess the prevalence and effects of prominent HCC risk factors in Louisiana to support strategies for prevention and treatment in high-risk populations.

Methods: This matched 1:1 case-control study used cancer registry records and electronic health records obtained from the Louisiana Tumor Registry and Louisiana Public Health Institute's Research Action for Health Network to identify cases of invasive HCC and disease-free controls. A total of 1,389 HCC cases were matched to HCC-free controls on age, sex, race, and health system. Clinical diagnoses of risk factors were identified using International Classification of Disease diagnosis codes in the medical record for both cases and controls. Conditional logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (95% CI), including a model of two-way interactions.

Results: HCV was the most prominent risk factor among cases (63.4%), followed by type 2 diabetes (39.3%), alcohol use disorder (26.4%), metabolic dysfunction-associated steatotic liver disease (MASLD, 17.5%), and hepatitis B virus (8.9%). HCV was associated with an increased risk of HCC (OR = 192.0; 95% CI: 64.3-570), as were hepatitis B (OR = 94.1; 95% CI: 11.4-776), AUD (OR = 33.2; 95% CI: 11.4-96.7), MASLD (OR = 6.5; 95% CI: 3.2-13.2), and type 2 diabetes (OR = 2.0; 95% CI: 1.4-2.8). A significant antagonistic interaction was observed between HCV and MASLD (p = 0.002).

Conclusion: This study identified highly prominent risk factors for HCC among Louisiana high-risk populations. Unfortunately, Louisiana faces several challenges regarding HCC trends and risk factors, particularly viral hepatitis, metabolic dysfunction, and alcohol use. This calls for new and innovative strategies to address risk factors and support the prevention, control, and treatment of HCC. Further insight on the novel antagonistic relationship between HCV and MASLD is necessary to understand the complex biological pathway between the two risk factors.