Risk factors for the development of hepatocellular carcinoma in Chengdu: a prospective cohort study

OBJECTIVE: To investigate the incidence of hepatocellular carcinoma (HCC) in Chengdu, identify the risk factors for the devel-opment of HCC in Chengdu and provide a refer-ence for the prevention of HCC. PATIENTS AND METHODS: The study pop-ulation was recruited from Chengdu, Sichuan Province, China. The study group recruited vol-unteers in Chengdu from 2007 to 2012, conduct-ed a baseline survey, and subsequently con-ducted long-term follow-up until December 31, 2019. A total of 22,525 study subjects were en-rolled, excluding those who reported a previous history of liver disease, malignancy, and HCC within three months of enrollment. Cox pro-portional risk regression models were used to screen and determine the various risk factors and their hazard ratios (HR) for HCC in Cheng-du, as well as to determine whether the associ-ation between other risk factors and HCC was modified by gender. RESULTS: The study population had a median follow-up of 5.35 years, and a total of 142 people developed HCC, with an incidence rate of 0.71%. Analysis of the multifactorial Cox proportion-al risk regression model showed that age (age 10 years for 1 group, HR= 1.98, 95% CI: 1.86-2.11, p<0.001), current smoking (HR= 1.25, 95% CI: 1.07-1.31, p=0.031), weekly consumption of pickled vegetables (HR= 1.70, 95% CI: 1.49-1.81, p=0.003) and consumption of pickled vegeta-bles daily (HR= 1.36, 95% CI: 1.21-1.42, p=0.021) were risk factors for HCC, and women (HR= 0.39, 95% CI: 0.28-0.55, p=0.002) and the use of air conditioning (10 years for 1 group, HR= 0.79, 95% CI: 0.68-0.83, p=0.002) were protective fac-tors against HCC. Further analysis revealed that the association between length of time using air conditioning and HCC was heterogeneous among men and women (p=0.007) and that there was an interaction between sex and use of air conditioning in the association with HCC devel-opment (p<0.001). CONCLUSIONS: The Chengdu population has a high incidence of HCC and numerous risk factors for HCC. There is a synergistic interac-tion between sex and length of time using air conditioning in their role in the development of HCC.