Methods  The data of 670 PBC inpatients between January 2011 and December 2016 were collected from the database of The First Affiliated Hospital of Zhengzhou University. The potential risk factors were evaluated, and odds ratios (ORs) and 95% confidence intervals (CIs) were analyzed by univariate (unadjusted OR) and multivariateadjusted OR (AOR) conditional Logistic regression.

  Results  In total, 35 PBC patients developed liver carcinoma (5.2%); of these, 4 patients (female) were excluded because of incomplete data for influencing factors and 6 (2 male; 4 female) were excluded as they were diagnosed with hepatocellular carcinoma (HCC) during or before PBC. Therefore, 25 patients were included in the case-control study. Male patients were more likely than female patients to show alcohol intake, smoking, a family history of malignancy, and serious liver injury (all P < 0.05), indicated by the increasing levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma glutamyl transferase (GGT)(P < 0.05). Conditional Logistic regression analysis revealed that body mass index (BMI) ≥ 25 kg/m² (AOR=1.015, 95% CI:1.001-1.257, P=0.032) and history of alcohol intake (AOR=10.014, 95% CI:1.009-91.071, P=0.039) were significantly associated with increased odds of HCC development in PBC patients.

  Conclusions  The risk factors for PBC-associated liver carcinoma include BMI ≥ 25 kg/m² and history of alcohol intake. In addition to regular monitoring, PBC patients may benefit from alcohol abstinence and body weight control.