The pathogenesis of
hepatocellular carcinoma (HCC) related to habitual betel quid (BQ) chewing is unclear. Risk of HCCis increased with adverse hepatic
fibrosis. This study aimed to assess the impact of chronic viral
hepatitis on adverse hepatic
fibrosis in HCC related to BQ chewing. This hospital-based case-control study enrolled 200 pairs of age- and gender-matched patients with HCC and unrelated healthy controls. Serologic
hepatitis B surface antigen (
HBsAg),
antibodies to hepatitis C virus (anti-HCV), α-
fetoprotein (AFP), and
surrogate markers for significant hepatic
fibrosis were measured. Information on
substance-use habits was obtained with a questionnaire. By analysis of
surrogate markers for hepatic
fibrosis, the prevalence of significant hepatic
fibrosis in patients chewing BQ was between 45.8% and 91.7%, whereas that for patients without BQ chewing was between 18.4% and 57.9%. The difference was significant (P <0.05 for each
surrogate marker). Multivariate analysis indicated that
cirrhosis with Child-Pugh C (odds ratio (OR) = 3.28; 95% confidence interval (CI), 1.29- 8.37),
thrombocytopenia (OR = 3.92, 95% CI, 1.77-8.68), AFP >400 mg/L (OR = 2.21, 95% CI, 1.05-4.66) and male gender (OR = 4.06, 95% CI, 1.29-12.77) were independent factors associated with habitual BQ chewing. In conclusion, adverse hepatic
fibrosis and severe liver damage play important roles in the pathogenesis of BQ- related HCC, which could be aggravated by
chronic hepatitis B and
hepatitis C. BQ-cessation programs and prevention of chronic HBV/HCV
infection are needed to prevent HCC related to BQ chewing.