Risk and Predictive Factors for Liver Cancer : Analysis of Data from a Cohort Study

University essay from Linköpings universitet/Linköpings universitet/StatistikTekniska högskolan


The association between the risk of liver cancer and blood chemistry was investigated in a cohort study with 95,150 men and women from two counties in Sweden. In 1963-65, blood tests and physical measurements were undertaken. All individuals were then followed up until 2007, and a total of 312 were diagnosed with liver cancer. Using survival analysis and logistic regression, significant risk factors were identified. Stepwise Cox proportional hazards regression applied to a main effect model revealed that Glutamic Pyruvate Transaminase (GPT) and Thymol Turbidity (TYM) were the most significant risk factors (p<0.0001), followed by Protein-Bound Hexoses (HEX)  (p=0.002), sex (p=0.02), and Serum Iron (p= 0.03). Increasing the level of GPT expressed in U/L from normal (<21) to slightly elevated (21, 31) or substantially elevated (>31) raised the hazard of experiencing liver cancer by a factor of 1.45 and 4.09, respectively. In addition, GPT was found to be the most significant risk factor in almost all age groups among both men and women. However, there was no evidence that elevated GPT levels within the normal range (<21), influenced the risk of liver cancer. Additional subgroup analyses revealed that TYM was highly significant within the group with normal GPT, and a high level of HEX (≥134 mg/dl) increased the hazard 1.55 times in comparison with the lowest HEX group (<115 mg/dl). BMI was significant only in the male subgroup  (p<0.01) and, in the obesity group, the hazard of experiencing liver cancer was 1.99 times higher than in the normal BMI group. A significant three-way interaction between GPT, BMI and gender was present (p=0.05) with a robust significant two-way interaction between GPT and BMI (p<0.01) in the male subgroup.

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