Age, gender, and local geographic variations of viral etiology of hepatocellular carcinoma in a hyperendemic area for hepatitis B virus infection

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Abstract
BACKGROUND There are etiologic variations of hepatocellular carcinoma (HCC) in different geographic areas. Taiwan is a hyperendemic area for hepatitis B virus (HBV) infection. Hepatitis C virus (HCV) infection also plays an important role in HCC development in Taiwan. Identification of local HCV‐endemic areas is important to keep HCV from spreading. This study investigated the etiologic variations of HCC in different geographic areas of Taiwan. METHODS The authors evaluated the hepatitis B surface antigen (HBsAg) and antibodies to HCV (anti‐HCV) status of 284 patients (232 male, 52 female) with HCC. They also evaluated the gender ratio and mean age of these patients. RESULTS The mean age of HBsAg positive patients was significantly lower than the mean age of HBsAg negative patients (52.6 ± 12.3 vs. 61.3 ± 11.2 years) (P < 0.05). The male‐to‐female ratio was 4.5:1 for all HCC patients, 7:1 for HBsAg positive HCC patients, and 2.8:1 for anti‐HCV positive HCC patients. In Chaiyi County in southern Taiwan, the prevalence of anti‐HCV in male HCC patients was 52%, significantly greater than that of Taiwan as a whole (27.6%) (P = 0.07). However, the prevalence of anti‐HCV in male HCC patients in Taipei County in northern Taiwan was 8.7%, significantly less than that of Taiwan as a whole (P = 0.043). Of a total of 65 Chiayi‐based HCC patients, 55.4% were anti‐HCV positive and 46.2% were HBsAg positive. In the Chiayi area, results of multiple logistic regression showed that the HCC patients who were age 60 years or older or who were living in the city area both had highly HCV‐related disease. CONCLUSIONS The mean age of patients with HBV‐related HCC was significantly lower than that of patients with non‐HBV‐related HCC. The male‐to‐female ratio for patients with HBV‐related HCC was significantly higher than that of patients with HCV‐related HCC. The authors identified an area of Taiwan in which HCV‐related HCC was prevalent. Cancer 1999;86:1143–50. © 1999 American Cancer Society.