Profile of hepatocellular carcinoma in India: An insight into the possible etiologic associations

Background: Several etiologic factors including hepatitis viruses, alcohol and aflatoxin have been implicated in the pathogenesis of hepatocellular carcinoma (HCC). There is, however, limited information from the Indian subcontinent. Methods: Seventy‐four consecutive cases of HCC were studied. A detailed history, tests for hepatitis B virus (HBV; HBsAg, HBeAg, anti‐HBe, IgG anti‐HBc, anti‐HBs and HBV‐DNA), hepatitis C virus (HCV; anti‐HCV and HCV‐RNA) infection, liver histopathology and HBV‐DNA integration by using Southern blot hybridization were studied. A p53 gene mutation was also studied by using PCR and single‐strand conformation polymorphism. Results: Hepatocellular carcinoma patients were predominantly males (mean age 49.5 ± 14.0 years). Portal hypertension and cirrhosis were seen in 56 (76%) patients, more often ( P < 0.05) in viral marker positive cases. Forty‐five percent of patients had features of hepatic decompensation at presentation. Evidence of HBV infection was present in 53 (71%) patients. Twenty‐six (49%) of these patients had either HBeAg + ve, HBV‐DNA + ve ( n = 12), or HBsAg – ve, HBV‐DNA + ve ( n = 14) forms of HBV infection. Hepatitis B virus DNA integration in the liver tissue was seen in 10 of 17 (59%) patients. Infection with HCV alone was detected in three (4%) and dual HBV and HCV infection in six (8%) patients. A majority (78.5%) of the chronic alcoholics had associated viral infection. The etiology of HCC remained undetermined in 15 (20%) patients. The p53 gene mutations were detected only in three of 21 (14%) liver tissues. Aflatoxin toxicity, oral contraceptive use or metabolic disorder were not seen. Conclusions: In India: (i) HBV infection is the predominant factor for the development of HCC, often related to mutant forms of HBV; (ii) a majority of the HCC patients have overt cirrhosis of the liver; and (iii) HCV and alcohol per se are uncommonly associated.