A modest association appears to exist between chronic hepatitis C virus (HCV) infection and incidence of esophageal cancer, according to a systematic review and meta-analysis published in the Journal of Clinical Gastroenterology.

Certain studies have suggested that chronic HCV infection is associated with multiple types of extrahepatic cancer, including pancreatic cancer, renal cell carcinoma, and non-Hodgkin lymphoma.

More recently, HCV infection has been associated with esophageal cancer, though results on the strength of this relationship are conflicting. Therefore, researchers conducted a systemic review and meta-analysis to investigate whether chronic HCV infection is associated with a higher incidence of esophageal cancer.

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Investigators searched the Embase and MEDLINE databases from inception to November 2019. A total of 20,459 articles were identified. Following 2 rounds of independent review, 7 studies met the inclusion criteria and were included in the meta-analysis.

The researchers found that chronic HCV infection was associated with a higher incidence of esophageal cancer, with a pooled relative risk of 1.61 (95% CI, 1.19-2.17). Analysis by year of publication was also conducted, in order to note any changes in the association between HCV infection and esophageal cancer over time. Pooled effect estimates increased over the years, as more studies were conducted and HCV treatments became more advanced. Additional analysis via funnel plot was conducted to rule out publication bias. Results did not suggest publication bias in favor of studies with positive results.

Investigators acknowledge the accuracy of these results could be limited, as several studies relied on claims or diagnostic codes from administrative databases that were not validated. In addition, the diagnosis of HCV infection included codes for both acute and chronic infection; however, the majority of patients with acute HCV infection eventually develop chronic HCV. Finally, due to the small number of eligible studies included in the analysis, publication bias cannot be ruled out completely. 

“This systematic review and meta-analysis demonstrated that there is a modest association between chronic HCV and incident esophageal cancer,” the authors concluded. “However, further studies are still required to investigate the causality and the exact pathophysiology of this association.”


Ponvilawan B, Rittiphairoj T, Charoenngam N, et al. Association between chronic hepatitis C virus infection and esophageal cancer. a systematic review and meta-analysis. J Clin Gastroenterol. 2022;56(1):55-63. doi: 10.1097/MCG.0000000000001532

This article originally appeared on Gastroenterology Advisor