Heavy drinking linked to 4-fold HCC hazard in 1010 chronic hepatitis B patients, Chinese cohort

Researchers at two medical centers in China report that higher alcohol intake is associated with a higher risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB). The retrospective cohort study, published in Clinical Gastroenterology and Hepatology, included 1010 patients enrolled between March 1, 2005, and December 30, 2025. Over 3684 person-years of follow-up, 129 patients (12.77%) developed HCC sciencedirect.comClinical Gastroenterology and Hepatologysciencedirect.comOpen source ↗.

Cohort and HCC incidence

The median age was 46 years, 81% of patients were men, and 51% had cirrhosis. In standardized interviews, 74% reported low alcohol consumption, 17% moderate and 9% high. Cumulative HCC incidence was 9.05%, 17.16% and 35.56% in the low, moderate and high groups, respectively. The 5-year Kaplan-Meier estimates were 11.41%, 21.00% and 47.31%.

Patients who developed HCC reported higher intake than those who did not: a median of 2.00 vs 0.00 × 100 g/week (P < .001). High consumption was reported by 24.81% of patients with HCC and 6.58% of those without. At each consumption level, the incidence rate per 100 person-years was higher in cirrhotic than in noncirrhotic patients: 3.04 vs 1.77 (low), 6.99 vs 2.77 (moderate) and 15.50 vs 9.25 (high).

Hazard ratios by intake and cirrhosis

In a multivariable Cox model, each 100 g/week increase in alcohol intake was associated with a higher HCC risk (adjusted hazard ratio, aHR, 1.33; 95% CI 1.21–1.46). High intake (>350/420 g/week) was compared with low intake (<140/210 g/week) and with low-to-moderate intake (≤350/420 g/week). The aHR was 4.00 (95% CI 2.36–6.78) against low and 3.48 (95% CI 2.21–5.48) against low-to-moderate sciencedirect.comClinical Gastroenterology and Hepatologysciencedirect.comOpen source ↗.

In patients with cirrhosis, the aHRs for the per-100-g increase, high vs low and high vs low-to-moderate were 1.32, 4.36 and 3.23. In patients without cirrhosis they were 1.44, 4.59 and 4.97. The associations were generally consistent across subgroups by age, hepatitis B e antigen status, hepatitis B virus DNA level, aMAP score and mPAGE-B score, with some variation among noncirrhotic patients.

The authors concluded that alcohol consumption independently increases HCC risk in CHB regardless of cirrhosis status, and pointed to the importance of systematic assessment and control of alcohol intake. They list as limitations uncertain generalizability beyond Asian men and community-based CHB cohorts, possible misclassification of alcohol use, and residual confounding due to the retrospective design.