Hepatocellular carcinoma and hepatitis B virus infection. Analysis of 75 cases from Switzerland

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Abstract
— The prevalence of serological markers of hepatitis B virus (HBV) infection was investigated in 75 patients with histologically confirmed hepatocellular carcinoma (HCC). Hepatitis Bs‐antigen (HBs‐Ag) was found in 30.8% and evidence of present or past infection in 61.5%. In a control group of 115 patients with liver cirrhosis of various etiologies in whom evidence of a coexistent HCC was lacking, the corresponding numbers were significantly lower (16.5% and 41.7% resp., p<0.05). Below the age of 65 years, markers of present or past HBV‐infection were significantly more frequent than in patients above 65 years of age (p<0.025). All patients positive for HBs‐Ag had an underlying cirrhosis; in seven cases, HCC was found in a non‐cirrhotic liver. Alpha‐fetoprotein measurements failed to identify patients with HCC in up to 43.6% of the HBs‐Ag negative cases. It is concluded that HBV‐infection does represent a cofactor in the malignant transformation of the liver, even in areas of lower incidence. Alpha‐fetoprotein measurements need to be complemented by other investigations if early recognition of HCC is to lead to better survival.