A prospective follow-up study of the relationship between high-sensitivity C-reactive protein and primary liver cancer
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RESEARCH ARTICLE
Open Access
A prospective follow-up study of the relationship between high-sensitivity Creactive protein and primary liver cancer Sarah Tan Siyin1†, Tong Liu1†, Wenqiang Li1, Nan Yao1, Guoshuai Xu1, Jun Qu1*
and Yajun Chen2
Abstract Background: Competing risk method has not been used in a large-scale prospective study to investigate whether increased levels of high-sensitivity C-reactive protein (hs-CRP) elevate the risk of primary liver cancer (PLC). Our study aims to prospectively investigate the relationship between hs-CRP and new-onset PLC. Methods and results: Ninety-five thousand seven hundred fifty-nine participants without the diagnosis of PLC, and who had their demographic characteristics and biochemical parameters recorded, were analyzed from the Kailuan Cohort study. Cox proportional hazards regression models and competing risk regression models were used to evaluate the hazard ratios (HRs) and 95% confidence intervals (95% CIs) of PLC. During a median follow-up of 11.07 years, 357 incidental PLC cases were identified over a total of 1,035,039 person-years. The multivariable HRs (95%CI) for the association of hs-CRP of 1–3 mg/L group and hs-CRP>3 mg/L with PLC were 1.07(0.82 ~ 1.38), 1.51(1.15 ~ 1.98) in a Cox proportional hazard regression analysis adjusted for other potential confounders. In the cause-specific hazard model, the multivariable HRs (95%CI) for the association of hs-CRP of 1–3 mg/L group and hs-CRP>3 mg/L with PLC were 1.06(0.81 ~ 1.40), 1.50(1.14 ~ 1.99). Similar results were also observed in the sub-distribution hazard function model with corresponding multivariate HRs (95%CI) of 1.05(0.80 ~ 1.40), 1.49(1.13 ~ 1.98) in hs-CRP of 1–3 mg/L group and hs-CRP>3 mg/L group, respectively. Conclusions: This prospective study found a significant association of higher levels of hs-CRP with new-onset PLC. The main clinical implications would be an increased awareness of hs-CRP and its correlation to the risk of PLC. This study should be a steppingstone to further research on chronic inflammation and PLC. Trial registration: Registration number: ChiCTR–TNRC–11001489. Keywords: Primary liver cancer, Incidence, High-sensitivity C-reactive protein, Competing risk models, Cohort
Background Primary liver cancer (PLC) is well recognized as one of the leading causes of cancer-related death globally, with hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) being the most common, * Correspondence: [email protected] † Sarah Tan Siyin and Tong Liu contributed equally to this manuscript and share the first author. 1 Department of General Surgery, Aerospace Center Hospital, Yuquan Road 13, Haidian District, Beijing 100089, China Full list of author information is available at the end of the article
accounting for approximately 70 and 15% respectively [1]. World Health Organization revealed 841,080 new incidents and 781,631 deaths of PLC in 2018 worldwide. PLC incidence rates vary geographically, with East and South-East Asia consistently having the highest rates and r
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