Effect of smoking on survival of patients with hepatocellular carcinoma

• Published in: Liver international Vol. 37; no. 11; pp. 1682 - 1687
• Main Authors: Kolly, Philippe, Knöpfli, Marina, Dufour, Jean‐François
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01-11-2017
• Subjects: Adult; Aged; Aged, 80 and over; Alcohol Drinking - adverse effects; Carcinoma, Hepatocellular - mortality; Confidence intervals; Confounding Factors (Epidemiology); Etiology; Female; Health risks; Hepatitis; Hepatitis B; Hepatitis B - complications; hepatitis B virus; Hepatitis C; Hepatitis C - complications; hepatitis C virus; Hepatocellular carcinoma; Humans; Kaplan-Meier Estimate; Life Style; Liver; Liver cancer; Liver diseases; Liver Neoplasms - mortality; Male; Middle Aged; Patients; Physical activity; Proportional Hazards Models; Prospective Studies; Regression analysis; Risk Assessment; Risk Factors; Smoking; Smoking - adverse effects; Smoking - epidemiology; Statistical analysis; Survival; Switzerland - epidemiology; Synergistic effect; Tobacco; Viruses; Switzerland; hepatitis C virus; hepatitis B virus; hepatocellular carcinoma; smoking; survival
• ISSN: 1478-3223; 1478-3231
• DOI: 10.1111/liv.13466

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.