ArticleHepatology (Baltimore, Md.)2019
Smoking and Hepatitis B Virus-Related Hepatocellular Carcinoma Risk: The Mediating Roles of Viral Load and Alanine Aminotransferase.
Article in Hepatology (Baltimore, Md.), 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
27 citing papers in PubMed, 44 citations in OpenAlex.
- Chronic viral hepatitis with concurrent metabolic dysfunction-associated steatotic liver disease: dual etiology challenges.Clinical and molecular hepatology · 2026Review
- Lifestyle factors in hepatocellular carcinoma: From pathogenesis to prognosis.World journal of clinical oncology · 2025Review
- Impact of Socio-Economic, Behavioural and Clinical Factors on Liver Disease Progression in Individuals With HIV and Hepatitis B.Liver international : official journal of the International Association for the Study of the Liver · 2025Observational
- Unhealthy Behaviours and All-Cause Mortality Among People With Chronic Hepatitis B, With and Without Hepatitis Delta (ANRS CO22 HEPATHER).Journal of viral hepatitis · 2025Article
- Behaviour-Based Predictive Scores of Hepatocellular Carcinoma in People With Chronic Hepatitis B (ANRS CO22 HEPATHER).Liver international : official journal of the International Association for the Study of the Liver · 2025Article
- The Malignant Transformation of Viral Hepatitis to Hepatocellular Carcinoma: Mechanisms and Interventions.MedComm · 2025Review
- Impact of age at HBsAg seroclearance on hepatic outcomes and life expectancy in men with chronic HBV infection based on multi-state modeling of the natural history.Journal of gastroenterology · 2025Article
- Heavy smoking increases early mortality risk in patients with hepatocellular carcinoma after curative treatment.Journal of liver cancer · 2024Article
- Comorbidities and Monitoring in Patients with Chronic Hepatitis B on Nucleos(t)ide Analogues Attending a Tertiary Hospital in Malaysia, Southeast Asia: A Critical Perspective.The Malaysian journal of medical sciences : MJMS · 2024Article
- Liver toxicity in rats after subchronic exposure to HTP aerosol and cigarette smoke.Toxicology research · 2024Article
- Impacts of smoking on alcoholic liver disease: a nationwide cohort study.Frontiers in public health · 2024Article
- Associations of Race and Ethnicity with Hepatocellular Carcinoma, Decompensation, and Mortality in US Veterans with Cirrhosis.Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology · 2023Article
- Review
- Effect of lifestyle modification on hepatocellular carcinoma incidence and mortality among patients with chronic hepatitis B.World journal of gastroenterology · 2023Article
- Predictive Biomarkers for Immune-Checkpoint Inhibitor Treatment Response in Patients with Hepatocellular Carcinoma.International journal of molecular sciences · 2023Review
- Comprehensive investigating of mismatch repair genes (MMR) polymorphisms in participants with chronic hepatitis B virus infection.Frontiers in genetics · 2023Article
- Estimates of prevalence, time-trend, and association of smoking in adults living with HIV, HBV, and HCV (NHANES 1999-2018).Scientific reports · 2022Article
- Risk Factors and Biomarkers for Chronic Hepatitis B Associated Hepatocellular Carcinoma.International journal of molecular sciences · 2021Review
- Targeting Immune Cells in the Tumor Microenvironment of HCC: New Opportunities and Challenges.Frontiers in cell and developmental biology · 2021Review
- Incidence and Influencing Factors of New Hepatitis B Infections and Spontaneous Clearance: A Large-Scale, Community-Based Study in China.Frontiers in medicine · 2021Article
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Authors and funding
13 authors at 6 institutions in 1 country.
Funding
Abstract
Smoking interacts with hepatitis B virus (HBV) to increase the risk of hepatocellular carcinoma (HCC), which might be explained by its role in antiviral immunity. We evaluated the potential mediating role of viral load and/or alanine aminotransferase (ALT) in the relation of smoking with HBV-associated HCC risk. Using multiple mediation analyses to analyze data from 209 HCC cases and 1,256 controls nested within a cohort of 4,841 male HBV carriers, we found that the effect of smoking on the risk of subsequent HCC was substantially mediated through viral load (percent mediated, 31.7%; P = 0.0054), and a significant mediation effect by both viral load and ALT was also evidenced. Among the 1,143 subjects with repeated measures of viral load and ALT over periods of up to 16 years, we further observed that a higher number of pack-years of smoking was associated with higher viral load, maintenance of a high viral load (>4.39 log copies/mL), more severe hepatotoxicity grade, and increased likelihood of ALT ≥80 U/L (odds ratio, 3.14; 95% confidence interval, 1.03-9.64; odds ratio, 6.06; 95% confidence interval, 1.10-33.25, respectively, for 10-19 and ≥20 pack-years versus nonsmokers) during follow-up. Furthermore, plasma interferon-γ levels were reduced in smokers compared with nonsmokers (interferon-γ-positive rate, 14.9% versus 28.7%; P < 0.0001) at baseline. Smoking was also associated with a reduced natural killer (NK) cell frequency in peripheral blood, characterized by reduced NK function through a systems immunology approach, after long-term follow-up in a subsample (n = 171). The combination of smoking and reduced NK cell frequency further increased viral load and the likelihood of ALT ≥80 U/L. Conclusion: The data highlight a role of smoking in HBV viral load, underlining the importance of smoking prevention and cessation in hepatitis B management.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.