Association between Hepatitis C Virus Infection and Esophageal Cancer: An Asian Nationwide Population-Based Cohort Study

• Main Authors: Yin-Yi Chu, Jur-Shan Cheng, Ting-Shu Wu, Chun-Wei Chen, Ming-Yu Chang, Hsin-Ping Ku, Rong-Nan Chien, Ming-Ling Chang
• Format: Article
• Language: English
• Published: MDPI AG 2021-05-01
• Series: Journal of Clinical Medicine
• Subjects: HCV; esophageal cancer; male; interferon; mortality
• Online Access: https://www.mdpi.com/2077-0383/10/11/2395

<b>Background:</b> Hepatitis C virus (HCV) infection causes many extrahepatic cancers, and whether HCV infection is associated with esophageal cancer development remains inconclusive. <b>Methods:</b> A nationwide population-based cohort study of the Taiwan National Health Insurance Research Database (TNHIRD) was conducted. <b>Results:</b> From 2003 to 2012, of 11,895,993 patients, three 1:1:1 propensity score-matched cohorts, including HCV-treated (interferon-based therapy ≧6 months, <i>n</i> = 9047), HCV-untreated (<i>n</i> = 9047), and HCV-uninfected cohorts (<i>n</i> = 9047), were enrolled. The HCV-untreated cohort had the highest 9-year cumulative incidence of esophageal cancer among the three cohorts (0.174%; 95% confidence interval (CI): 0.068–0.395) (<i>p</i> = 0.0292). However, no difference in cumulative incidences was identified between the HCV-treated (0.019%; 0.002–0.109%) and HCV-uninfected cohorts (0.035%; 0.007–0.133%) (<i>p</i> = 0.5964). The multivariate analysis showed that HCV positivity (hazard ratio (HR): 5.1, 95% CI HR: 1.39–18.51) and male sex (HR: 8.897; 95% CI HR: 1.194–66.323) were independently associated with the development of esophageal cancer. Of the three cohorts, the HCV-untreated cohort had the highest cumulative incidence of overall mortality at 9 years (21.459%, 95% CI: 18.599–24.460) (<i>p</i> < 0.0001), and the HCV-treated (12.422%, 95% CI: 8.653–16.905%) and HCV-uninfected cohorts (5.545%, 95% CI: 4.225–7.108%) yielded indifferent cumulative mortality incidences (<i>p</i> = 0.1234). <b>Conclusions:</b> Although HCV positivity and male sex were independent factors associated with esophageal cancer development, whether HCV infection is the true culprit or a bystander for developing esophageal cancer remains to be further investigated. Interferon-based anti-HCV therapy might attenuate esophageal risk and decrease overall mortality in HCV-infected patients.