Engels from the U.S. National Cancer Institute and colleagues
from South Korea performed a study to assess whether chronic
hepatitis B increased the risk of subsequent development
of NHL among patients in South Korea. HBV prevalence has historically
been high in Korea -- as it is throughout Asia -- though lower
today due to successful vaccination campaigns.
researchers looked at participants in the Korean Cancer Prevention
Study, a cohort of South Korean workers and their dependants
enrolled during 1992-1995. They excluded individuals who died
before January 1, 1993, those who had cancer at or before
the initial study visit, those with a history of heavy alcohol
use, people with HIV
or hepatitis C virus (HCV)
coinfection, and those missing information about height, weight,
or alanine aminotransferase (ALT) or aspartate aminotransferase
of 1,284,586 eligible participants, a total of 603,585 had
available baseline data on hepatitis B surface antigen (HBsAg)
status and were included in the analysis. People who tested
positive for HBsAg at baseline were considered to have chronic
continued for up to 14 years, through December 31, 2006. The
study authors used national databases of inpatient and outpatient
diagnoses and death records to determine occurrence of blood-related
malignancies. They assessed the incidence (new cases) of NHL
overall and of NHL subtypes, malignant immunoproliferation,
Hodgkin's lymphoma, multiple myeloma, and various types of
of the 603,585 eligible participants, 53,045 (8.8%) tested
HBsAg positive at baseline.
133 HBsAg positive participants and 905 HBsAg negative
individuals developed NHL, for incidence rates of 19.4
vs 12.3 per 100,000 person-years, respectively.
positive participants had an increased risk of NHL overall
compared with HBsAg negative people after adjusting for
sex, age, and year of study enrollment (adjusted hazard
ratio [HR] 1.74, or nearly twice the risk).
at NHL subtypes, HBsAg positivity was associated with
increased risk of diffuse large B-cell lymphoma (325 cases,
incidence rates 6.9 vs 3.8 per 100,000 person-years; adjusted
HR 2.01), as well as malignancies of unknown subtype.
positive participants also had an increased risk of malignant
immunoproliferation (14 cases, incidence rates 0.4 vs
0.2 per 100,000 person-years; adjusted HR 3.79).
for these malignancies was consistently higher among HBsAg
positive participants throughout 14 years of follow-up.
HBsAg positive was not, however, associated with follicular
or T-cell NHL, Hodgkin's lymphoma, multiple myeloma, or
on these findings, the study authors concluded, "During
extended follow-up, HBsAg positive individuals had an increased
risk of NHL, suggesting that chronic HBV infection promotes
of Cancer Epidemiology and Genetics, National Cancer Institute,
Rockville, MD; Institute of Human Genomic Study, College of
Medicine, Korea University, Seoul, South Korea; Department
of Epidemiology, Institute for Health Promotion, Graduate
School of Public Health, Yonsei University, Seoul, South Korea
Engels, ER Cho, and SH Jee. Hepatitis B virus infection and
risk of non-Hodgkin lymphoma in South Korea: a cohort study.
Lancet Oncology (Abstract).
August 4, 2010 (Epub ahead of print).