Alcohol consumption increases risk of hepatocellular carcinoma in chronic hepatitis B patients.

BACKGROUND: Both chronic hepatitis B (CHB) and alcohol consumption are risk factors for hepatocellular carcinoma (HCC). However, their synergistic effect on HCC development is not fully elucidated. Therefore, we evaluated the association between alcohol consumption and HCC development in CHB patients. METHODS: Patients with CHB were enrolled between March 1, 2005 and December 30, 2025 at two medical centers in China. COX proportional hazards regression model and Kaplan-Meier curves were used to evaluate the association between alcohol consumption and HCC risk in CHB patients. RESULTS: A total of 1,010 CHB patients were included, among whom 129 (12.77%) developed HCC during 3,684 person-years of follow-up. Compared to those without HCC, CHB patients with HCC had higher alcohol intake levels (2.00 vs. 0.00×100 g/week, P<0.001). Multivariable Cox regression showed that each 100 g/week increase in alcohol intake was associated with a higher risk of HCC (adjusted hazard ratio [aHR] 1.33, P<0.001) in CHB patients. Compared with low (<140/210 g/week) and low-to-moderate (≤350/420 g/week) alcohol intake, high alcohol intake (>350/420 g/week) was associated with an increased risk of HCC (aHR 4.00 and 3.48, respectively; both P<0.001). In stratified analyses, similar associations were observed in both cirrhotic (aHR 1.32, 4.36, and 3.23) and non-cirrhotic CHB patients (aHR 1.44, 4.59 and 4.97). These associations were consistent across subgroups defined by age, HBeAg status, HBV DNA level, aMAP score, and mPAGE-B score. CONCLUSIONS: Alcohol consumption independently increases HCC risk among CHB patients, regardless of cirrhosis status. These findings highlight the importance of systematic assessment and control of alcohol intake to reduce HCC risk in CHB patients.