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AETIOPATHOGENESIS OF HEPATOCELLULAR CARCINOMA
Author(s) -
HWANG SHINNJANG,
TONG MYRON J.,
LAI PAUL PC.,
KO EDISON S.,
CO RUTH L.,
CHIEN DAVID,
KUO GEORGE
Publication year - 1996
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/j.1440-1746.1996.tb00279.x
Subject(s) - medicine , hepatocellular carcinoma , hbsag , gastroenterology , hepatitis c virus , hepatitis b virus , liver disease , hepatitis , carcinoma , virus , immunology
In order to evaluate the roles of hepatitis B virus (HBV) and hepatitis C virus (HCV) and their clinical significance in Asian‐American and Caucasian patients with hepatocellular carcinoma (HCC) in the USA, 110 HCC patients, seen in a community‐based teaching hospital in the Los Angeles area over a 10 year period, were enrolled. Seventy‐nine (72%) patients were Asian‐Americans and 31 (28%) were Caucasians. Of the 110 HCC patients, 69 (63%) were positive for serum hepatitis B surface antigen (HBsAg), 26 (24%) were positive for serum antibody to hepatitis C virus (anti‐HCV), five (all Asian‐Americans) were positive for both markers; 11 (10%) patients had a history of alcoholism. HBsAg was detected in 63 (80%) Asian‐American patients, significantly higher than in the six (19%) Caucasian HCC patients ( P < 0.01). Anti‐HCV was detected in 10 (32%) Caucasian and in 16 (20%) Asian‐American HCC patients ( P > 0.05). Among Asian‐American HCC patients, anti‐HCV was more prevalent in those who were HBsAg‐negative than in the HBsAg‐positive patients (69 vs 8%; P < 0.01). A history of alcoholism was obtained in nine (29%) Caucasian HCC patients, significantly higher than in the two (3%) Asian‐American HCC patients ( P < 0.05). Comparing HCC patients with positive HBsAg and with anti‐HCV, HBsAg‐positive HCC patients were younger, Asian‐Americans and predominantly male; 38% had a family history of liver disease. In contrast, anti‐HCV‐positive HCC patients were older by nearly a decade and 46% had a history of blood transfusion. Using a stepwise logistic regression analysis, Asian race and patient age < 50 years were found to be independent predictors for HBsAg‐positivity, while a history of blood transfusion was the only predictor for anti‐HCV‐positivity in HCC patients. There was no significant difference in the rate of cirrhosis, serum levels of alpha‐fetoprotein and survival between HBsAg‐positive and anti‐HCV‐positive HCC patients. In conclusion, chronic HBV infection was the major aetiological factor in Asian‐American HCC patients, while chronic HCV infection and alcoholism were major aetiological factors in Caucasian HCC patients in the USA.