© 2000 by Oxford University Press
Journal of the National Cancer Institute, Vol. 92, No. 24, 2023-2028,
December 20, 2000
© 2000 Oxford University Press
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Androgen-Receptor Gene CAG Repeats, Plasma Testosterone Levels, and Risk of Hepatitis B-Related Hepatocellular Carcinoma
Affiliations of authors: M.-W. Yu, S.-W. Cheng, S.-Y. Yang, H.-C. Chang, C.-J. Chen (Graduate Institute of Epidemiology, College of Public Health), P.-J. Chen, C.-J Liu (Department of Internal Medicine, College of Medicine), National Taiwan University, Taipei; M.-W. Lin, Laboratory of Epidemiology and Biostatistics, Department of Medical Research and Education, Veterans General Hospital, Taipei; Y.-F. Liaw, S.-M. Lin, Liver Research Unit, Chang-Gung Memorial Hospital, Chang-Gung University, Taipei; T.-J. Hsiao, Department of Internal Medicine, Tao-Yuan General Hospital, Department of Health, The Executive Yuan, Tao-Yuan, Taiwan; S.-D. Lee, Department of Medicine, Veterans General Hospital and School of Medicine, National Yang-Ming University, Taipei.
Correspondence to: Ming-Whei Yu, Ph.D., Graduate Institute of Epidemiology, College of Pub-lic Health, National Taiwan University, No. 1 Jen-Ai Rd., Sec. 1, Rm. 1550, Taipei 100, Taiwan (e-mail: mingwhei{at}ha.mc.ntu.edu.tw).
Background: Worldwide, hepatocellular carcinoma (HCC) is more prevalent in men than in women, suggesting that sex hormones and/or X-chromosome-linked genes may be involved in hepatocarcinogenesis. We investigated the association of a trinucleotide (CAG) repeat in the androgen receptor (AR) gene (located on the X chromosome) termed "AR-CAG repeats," levels of plasma testosterone, and the risk of HCC in Taiwanese men. Chronic hepatitis B virus (HBV) infection, which is associated with risk of HCC, is hyperendemic in Taiwan. Methods: We compared the number of AR-CAG repeats in 285 HBV carriers with HCC and in 349 HBV carriers without HCC. We also conducted a nested casecontrol study on participants in a cohort study. Blood was collected prospectively from 110 case patients and 239 control subjects and was used to determine the number of AR-CAG repeats and plasma testosterone level. All statistical tests were two-sided. Results: The overall odds ratio (OR) for HCC was 1.72 (95% confidence interval [CI] = 1.032.89) for HBV carriers with 20 or fewer AR-CAG repeats compared with those with more than 24 repeats. This association was observed only in patients with late-onset HCC (OR = 2.37; 95% CI = 1.284.38). In the nested casecontrol study, HBV carriers in the highest tertile of testosterone levels had a statistically significantly increased risk of HCC (OR = 2.06; 95% CI = 1.143.70) compared with those in the lowest tertile. Elevated testosterone was more strongly associated with early-onset (OR = 4.67; 95% CI = 1.4115.38) than late-onset disease. HBV carriers with 20 or fewer AR-CAG repeats and higher testosterone levels had a fourfold increase in HCC risk compared with those with more than 24 repeats and testosterone levels in the lowest tertile. Conclusions: Higher levels of androgen signaling, reflected by higher testosterone levels and 20 or fewer AR-CAG repeats, may be associated with an increased risk of HBV-related HCC in men.
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