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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
ARTICLE HIGHLIGHTS
Research background
Despite various efforts to reduce the incidence of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB), it remains a persistent issue. Reports suggest that host factors such as alcohol consumption, smoking, and obesity, in addition to viral factors, contribute to the development of HCC.
Research motivation
Few studies have investigated the impact of lifestyle modifications (LSM) on reducing the incidence of HCC and liver-related mortality in patients with CHB.
Research objectives
This study used a nationwide database in Korea to investigate whether improvements in at least one of the following lifestyle factors - drinking, smoking, and sedentary behavior - were associated with reductions in HCC incidence and liver-related mortality in patients with CHB.
Research methods
We analyzed patients with CHB who participated in the Korean National Health Insurance Service and who drank alcohol, smoked cigarettes, and were sedentary. Target trial emulation was used and covariates were adjusted through 2:1 propensity score matching.
Research results
With 48766 patients in the LSM group and 103560 in the control group, the LSM group had a lower adjusted hazard ratio for incident HCC and liver-related mortality compared to the control group. Within the LSM group, alcohol abstinence and smoking cessation were associated with lower adjusted hazard ratios for both outcomes.
Research conclusions
LSM, specifically alcohol abstinence and smoking cessation, were associated with a decreased risk of HCC in patients with CHB.
Research perspectives
The findings of this study suggest a need for active counseling for LSM in CHB patients, particularly alcohol abstinence and smoking cessation. Further investigation through a well-designed prospective cohort study is necessary to confirm these results.
