Meta-Analysis
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World J Gastroenterol. Jul 14, 2013; 19(26): 4234-4241
Published online Jul 14, 2013. doi: 10.3748/wjg.v19.i26.4234
Hepatitis B or C viral infection and risk of pancreatic cancer: A meta-analysis of observational studies
Jian-Hua Xu, Jin-Jian Fu, Xiao-Li Wang, Jia-Yong Zhu, Xiao-Hua Ye, Si-Dong Chen
Jian-Hua Xu, Jin-Jian Fu, Department of Pathogen Biology, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou 510515, Guangdong Province, China
Jian-Hua Xu, Xiao-Li Wang, Xiao-Hua Ye, Si-Dong Chen, Guangdong Key Laboratory of Molecular Epidemiology, School of Public Health, Guangdong Pharmaceutical University, Guangzhou 510006, Guangdong Province, China
Jian-Hua Xu, Jia-Yong Zhu, Institute of Pharmaceutical Bioactive Substances Research, Guangdong Pharmaceutical University, Guangzhou 510006, Guangdong Province, China
Jian-Hua Xu, Department of Clinical Laboratory, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510120, Guangdong Province, China
Jin-Jian Fu, Liuzhou Municipal Maternity and Child Healthcare Hospital, Liuzhou 545001, Guangxi Province, China
Author contributions: Xu JH and Fu JJ contributed equally to this work; Xu JH and Fu JJ designed the study, collected and analyzed the data and wrote the manuscript; Wang XL and Ye XH contributed to the discussion; Zhu JY and Chen SD contributed to the discussion and revised the manuscript.
Supported by International Cooperation Project of the Guangzhou Science and Technology Bureau, No. 2011J5200017; Guangdong Provincial Science and Technology Development Program, No. 2011B031800207
Correspondence to: Dr. Si-Dong Chen, Guangdong Key Laboratory of Molecular Epidemiology, School of Public Health, Guangdong Pharmaceutical University, 280 Waihuan Donglu, Guangzhou Higher Education Mega Center, Guangzhou 510006, Guangdong Province, China. chensidong1@126.com
Telephone: +86-20-39352100 Fax: +86-20-39352100
Received: January 5, 2013
Revised: April 12, 2013
Accepted: May 16, 2013
Published online: July 14, 2013
Processing time: 188 Days and 22.9 Hours
Abstract

AIM: To investigate if there is an association between hepatitis B virus (HBV) or hepatitis C virus (HCV) infection and the risk of pancreatic cancer.

METHODS: All relevant studies published before 11 October, 2012 were identified by a systematic search of MEDLINE, EMBASE, BIOSIS Previews and the Cochrane Library databases and with cross-referencing. The observational studies that reported RR or OR estimates with 95%CIs for the association between HBV or HCV and pancreatic cancer were included. A random-effects model was used to summarize meta-analytic estimates. The Newcastle-Ottawa quality assessment scale was applied to assess the quality of the methodology in the included studies.

RESULTS: A total of 8 eligible studies were selected for meta-analysis. Overall, chronic hepatitis B and inactive hepatitis B surface antigen (HBsAg) carrier state (HBsAg positive) had a significantly increased risk of pancreatic cancer with OR of 1.20 (95%CI: 1.01-1.39), especially in the Chinese population (OR = 1.30, 95%CI: 1.05-1.56). Past exposure to HBV (possible occult HBV infection) had an increased OR of pancreatic cancer risk (OR = 1.24, 95%CI: 1.05-1.42), especially among those patients without natural immunity [anti hepatitis B core (HBc) positive/hepatitis B surface antibody (anti HBs) negative], with OR of 1.67 (95%CI: 1.13-2.22). However, past exposure to HBV with natural immunity (anti-HBc positive/anti-HBs positive) had no association with pancreatic cancer development, with OR 0.98 (95%CI: 0.80-1.16), nor did the HBV active replication (hepatitis B e antigen positive status), with OR 0.98 (95%CI: 0.27-1.68). The risk of pancreatic cancer among anti-HBs positive patients was significantly lower than among anti-HBs negative patients (OR = 0.54, 95%CI: 0.46-0.62). Past exposure to HCV also resulted in an increased risk of pancreatic cancer (OR = 1.26, 95%CI: 1.03-1.50). Significant between-study heterogeneity was observed. Evidence of publication bias for HBV/HCV infection-pancreatic cancer association was not found.

CONCLUSION: Chronic HBV and HCV infection increases pancreatic cancer risk. Our findings underscore the need for more studies to confirm this potential relationship.

Keywords: Hepatitis B; Hepatitis C; Pancreatic cancer; Observational studies; Meta-analysis

Core tip: Based on the meta-analysis, we identified that chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infection is associated with pancreatic cancer, especially among Chinese population. Patients with past exposure to HBV/HCV should be screened for hepatocellular carcinoma and other malignancies, especially pancreatic cancer.