Risk Factors for Hepatocellular Carcinoma: Findings from a Case-Control Study in Vietnam

Liver cancer with a major type of hepatocellular carcinoma (HCC) is a leading cancer worldwide and in Vietnam, a low-and -middle income country in the Southeast Asia. While hepatitis B infection is an established risk factor little is known about other non-viral factors for HCC risk. We, therefore, conducted a hospital-based case-control study among 30 HCC patients and 118 healthy controls in Hanoi, Vietnam.

HCC was confirmed histopathologically while healthy controls were recruited at the same time in the same locations as HCC cases. Unconditional logistic regression was used to generate odds ratios (ORs) and 95% confidence intervals (CIs) for HCC in relations with potential risk factors.

Overall, age, sex, diabetes status, platelet, INR, AST, ALT, GGT, albumin, HDL, FIB-4 score, total bilirubin, and AST/ALT ratio were associated with increased risk of HCC. The ORs and respective 95% Cis were 1.08 (1.04-1.12) (per age incremental); 8.72 (3.04-24.95) (male vs. female); 10.05 (1.2-84.03) (diabetes compared with no-diabetes); 32.65 (6.6-161.44) (INR>1.0 compared with ≤1.0); 14.29 (4.52-45.25) (AST³40U/L compared with <40U/L); 4.40 (1.73-11.18) (ALT<41 U/L compared with ³41U/L); 12.06 (3.9-37.28) (albumin <35g/L compared with 35-50 g/L); 5.27 (1.69-16.47) (HDL≤0.9mmol/L compared with >0.9mmol/L); 4.20 (1.45-12.19) (FIB-4 1.3-2.67 compared with <1.3); 1.06 (1.01-1.10) (per unit incremental-total bilirubin); and 1.62 (1.03-2.26) (per unit incremental-NSF score). Other important factors, including BMI, smoking status, drinking status, cardiometabolic condition, cholesterol, triglyceride, and non-invasive fibrosis score (i.e., AST/ALT score, APRI, BARD) were not.

Our findings, for the first time, provided evidence of non-viral important risk factors for HCC in Vietnam.