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©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
Effect of lifestyle modification on hepatocellular carcinoma incidence and mortality among patients with chronic hepatitis B
Yewan Park, Danbee Kang, Dong Hyun Sinn, Hyunsoo Kim, Yun Soo Hong, Juhee Cho, Geum-Youn Gwak
Yewan Park, Department of Internal Medicine, Kyung Hee University Hospital, Seoul 02447, South Korea
Yewan Park, Dong Hyun Sinn, Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul 06355, South Korea
Danbee Kang, Juhee Cho, Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul 06355, South Korea
Danbee Kang, Hyunsoo Kim, Juhee Cho, Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University, Seoul 06351, South Korea
Dong Hyun Sinn, Geum-Youn Gwak, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, South Korea
Yun Soo Hong, Juhee Cho, Departments of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD 21287, United States
Author contributions: Park Y, Kang D, Cho J, and Gwak GY contributed to the study design; Kang D and Kim H contributed to the data collection and statistical analysis; Park Y and Kang D contributed to the drafting of the manuscript; Sinn DH, Hong YS, Cho J, and Gwak GY contributed to the critical review of the manuscript; Sinn DH, Cho J, and Gwak GY contributed to the study supervision; all the authors have full access to all of the data and take responsibility for the integrity of the data and accuracy of the data analysis.
Institutional review board statement: The use of the K-NHIS database was approved by the NHIS Review Committee (protocol number: NHIS-2021-1-575).
Informed consent statement: The institutional review board of Samsung Medical Center waived the requirement for informed consent for use of de-identified data. (Protocol number: SMC-2020-05-095).
Conflict-of-interest statement: All authors have nothing to disclose.
Data sharing statement: The corresponding author may provide data upon receipt of reasonable requests. However, due to restriction on information disclosure by the Korean National Insurance Service, data availability may be limited.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Danbee Kang, PhD, Professor, Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, 25-2 Sungkyunkwan-ro, Jongno-gu, Seoul 06355, South Korea. dbee.kang@gmail.com
Received: April 10, 2023
Peer-review started: April 10, 2023
First decision: April 28, 2023
Revised: May 13, 2023
Accepted: May 24, 2023
Article in press: May 24, 2023
Published online: June 28, 2023
BACKGROUND
Research exploring the influence of healthier lifestyle modification (LSM) on the risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB) is limited.
AIM
To emulate a target trial to determine the effect of LSM on HCC incidence and mortality among patients with CHB by large-scale population-based observational data.
METHODS
Among the patients with CHB enrolled in the Korean National Health Insurance Service between January 1, 2009, and December 31, 2017, those aged ≥ 20 years who drank alcohol, smoked cigarettes, and were sedentary were analyzed. Exposure included at least one LSM, including alcohol abstinence, smoking cessation, and regular exercise. The primary outcome was HCC development, and the secondary outcome was liver-related mortality. We used 2:1 propensity score matching to account for covariates.
RESULTS
With 48766 patients in the LSM group and 103560 in the control group, the adjusted hazard ratio (HR) for incident HCC and liver-related mortality was 0.92 [95% confidence interval (CI): 0.87-0.96] and 0.92 (95%CI: 0.86-0.99) in the LSM group, respectively, compared with the control group. Among the LSM group, the adjusted HR (95%CI) for incident HCC was 0.84 (0.76-0.94), 0.87 (0.81-0.94), and 1.08 (1.00-1.16) for alcohol abstinence, smoking cessation, and regular exercise, respectively. The adjusted HR (95%CI) for liver-related mortality was 0.92 (0.80-1.06), 0.81 (0.72-0.91), and 1.15 (1.04-1.27) for alcohol abstinence, smoking cessation, and regular exercise, respectively.
CONCLUSION
LSM lowered the risk of HCC and mortality in patients with CHB. Thus, active LSM, particularly alcohol abstinence and smoking cessation, should be encouraged in patients with CHB.
Core Tip: Unhealthy behaviors, including smoking, sedentary lifestyle, or alcohol drinking, are known to have adverse effect on the outcome among chronic hepatitis B (CHB) patients. However, there are limited data on the effect of healthier lifestyle modification (LSM), including quitting smoking, regular exercise, and quitting drinking, on the risk of hepatocellular carcinoma (HCC) in CHB patients. In this first hypothetical randomized trial, we demonstrated that the LSM lowers the risk of developing HCC by using the nationwide database. The findings of this study highlight the necessity for active counseling and therapeutic intervention for LSM in CHB patients.
