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Effect of smoking on survival of patients with hepatocellular carcinoma
Author(s) -
Kolly Philippe,
Knöpfli Marina,
Dufour JeanFrançois
Publication year - 2017
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.13466
Subject(s) - hepatocellular carcinoma , medicine , hazard ratio , proportional hazards model , confounding , confidence interval , prospective cohort study , hepatitis b virus , cohort study , hepatitis c virus , cohort , gastroenterology , oncology , immunology , virus
Background & Aims Lifestyle factors such as smoking, obesity and physical activity have gained interest in the field of hepatocellular carcinoma. These factors play a significant role in the development of hepatocellular carcinoma. Several studies revealed the impact of tobacco consumption on the development of hepatocellular carcinoma and its synergistic effects with viral etiologies (hepatitis B and C). The effects of smoking on survival in patients with a diagnosed hepatocellular carcinoma have not yet been investigated in a Western cohort where hepatitis C infection is a major risk factor. Methods Using data from a prospective cohort of patients with hepatocellular carcinoma who were followed at the University Hospital of Bern, Switzerland, survival was compared by Kaplan – Meier analysis in smokers and nonsmokers, and multivariate Cox regression was applied to control for confounding variables. Results Of 238 eligible hepatocellular carcinoma patients, 64 were smokers at the time of inclusion and 174 were nonsmokers. Smokers had a significant worse overall survival than nonsmokers (hazard ratio 1.77, 95% confidence interval: 1.22‐2.58, P =.003). Analysis of patients according to their underlying liver disease, revealed that smoking, and not nonsmoking, affected survival of hepatitis B virus and C virus‐infected patients only. In this subgroup, smoking was an independent predictor for survival (hazard ratio 2.99, 95% confidence interval: 1.7‐5.23, P <.001) and remained independently predictive when adjusted for confounding variables. Conclusions This study shows that smoking is an independent predictor of survival in hepatitis B virus/hepatitis C virus‐infected patients with hepatocellular carcinoma.