B형간염바이러스 감염과 췌장암 발생의 연관성에 관한 연구
The relationship between hepatitis B virus infection and the incidence of pancreatic cancer: a retrospective case-control study
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목적: B형 및 C형간염바이러스 감염은 간세포암의 주요 위험인자이며, 간내담도암과 비호지킨 림프종의 발생에도 기여한다고 알려져 왔다. 최근 B형간염바이러스의 잠재감염이 있는 경우에 췌장암의 발생이 유의하게 높다는 보고가 있었다. 하지만 B형간염의 유병률이 높은 지역에서의 연구는 부족한 실정으로 한국과 같이 유병률이 높은 지역에서 B형 및 C형간염바이러스 감염과 췌장암의 발생과의 연관성에 대해 알아보고자 하였다. 대상 및 방법: 2003년 1월부터 2007년 12월까지 췌장암으로 진단받은 환자를 대상으로 하였고, 대조군은 그 기간 동안의 위암 환자를 대상으로 2배수의 환자를 진단 시 연령과 성별로 짝짓기하여 선정하였다. 췌장암과 위암의 진단은 조직학적 진단과 경우에 따라 영상학적 소견을 포함한 임상적 진단으로 이루어졌다. 이들의 혈청 HBsAg, anti-HCV의 양성 유무를 확인하였고, 혼란 변수의 보정을 위해 췌장암의 위험인자인 흡연, 음주, 당뇨, 만성 췌장염의 병력에 대해서도 조사하였다. 결과: 췌장암 환자는 506명이었으며 위암 환자는 1,008명으로 조직학적으로 진단된 경우는 각각 58.1%와 97.3%였다. 이들의 평균 나이는 각각 63.5±11.1세, 63.9± 11.0세였고, 남녀비는 1.5:1로 연령과 성비에 차이를 보이지 않았다(P>0.05). 단변량 분석에서 HBsAg, anti-HCV 양성, 당뇨, 흡연, 음주, 만성 췌장염의 병력에 대한 교차비(95% 신뢰구간)가 각각 0.90 (0.52-1.56; P= 0.70), 1.87(0.87-4.01; P=0.11), 2.66(2.04-3.48; P<0.001), 2.30(1.83-2.90; P<0.001), 1.14(0.89-1.46; P=0.31), 4.40(1.66-11.66; P=0.003)이었고, 다변량 분석에서 췌장암 발생에 유의한 독립인자는 당뇨, 흡연, 만성 췌장염의 병력으로 교차비가 각각 2.67(2.00-3.56; P<0.001), 2.49(1.93-3.21; P<0.001), 4.60(1.56-13.53; P=0.006)이었다. 결론: 알려진 위험인자인 당뇨, 흡연, 만성 췌장염의 병력과 달리 HBsAg 및 anti- HCV 양성과 췌장암의 발생은 관련이 없었다. B형간염바이러스 유병률이 높은 지역에서 HBsAg 양성인 경우와 췌장암의 발생과의 관련성을 확인하기 위해 더 많은 연구가 필요할 것이다.
Abstract
Background/Aims: An association between past history of hepatitis B virus (HBV) infection and pancreatic cancer (PC) has recently been reported. We investigated whether HBV and hepatitis C virus (HCV) infections are associated with the development of PC in Korea. Methods: We retrospectively recruited patients with PC and sex- and, age-matched control patients with stomach cancer (SC) during the previous 5 years. Serum HBsAg and anti-HCV were examined, and data on smoking, alcohol intake, diabetes, and the history of chronic pancreatitis (CP) were collected. Results: A total of 506 PC and 1008 SC were enrolled, with respectively 58.1% and 97.3% of these cases being confirmed histologically. The mean age and sex ratio (male:female) were 63.5 years and 1.5:1 in the PC patients and 63.9 years and 1.5:1 in the SC patients respectively (P>0.05). The odds ratios (95% confidence interval, 95% CI) in univariate analysis were 0.90 (0.52-1.56; P=0.70) for HBsAg, 1.87 (0.87-4.01; P=0.11) for anti-HCV, 2.66 (2.04-3.48; P<0.001) for the presence of diabetes, 2.30 (1.83-2.90; P<0.001) for smoking, 1.14 (0.89-1.46; P=0.31) for alcohol intake, and 4.40 (1.66-11.66; P=0.003) for the history of CP. Independent risk factors for PC were presence of diabetes (OR, 2.67; 95% CI, 2.00-3.56; P<0.001), smoking (OR, 2.49; 95% CI, 1.93-3.21; P<0.001) and history of CP (OR, 4.60; 95% CI, 1.56-13.53; P=0.006). Conclusions: There was no significant association between seropositivity for HBsAg or anti-HCV and PC. Further studies are warranted to clarify the association between HBV infection and PC in regions where HBV is endemic.
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