Delta agent and the etiology of hepatocellular carcinoma

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Abstract
Sera from 87 patients with hepatitis B surface antigen (HBsAg)‐positive hepatocellular carcinoma (HCC) and from 29 HBsAg‐positive hospital controls were tested for delta (δ) antigen with an immunoenzymatic procedure and for anti‐δ antibody, hepatitis Be antigen (HBeAg) and antibody to HBeAg (anti‐HBe) by radioimmunoassay. All the sera, from both the HCC cases and the control patients, were negative for δ‐antigen. Among the HCC cases 9 were positive for serum anti‐δ (10%) whereas among the controls none was positive for this antibody (p = 0.067); the anti‐δ‐positive cases were found only among HCC patients negative for HBeAg. The lower prevalence of anti‐δ among HBsAg‐positive HCC patients, as compared to the corresponding prevalence among HBsAg‐positive patients with chronic active hepatitis or cirrhosis (reported in the literature) indicates that the pathogenesis of HCC is frequently independent of the pathogenesis of the other HBsAg‐positive common chronic liver diseases. By contrast, the higher prevalence of anti‐δ among HBsAg‐positive HCC cases than among HBsAg‐positive controls may reflect the longer average duration of the carrier state in HCC patients (until integration is accomplished and the induction period completed). Serum HBeAg was higher among HBsAg‐positive HCC patients with cirrhosis (23%) than among HBsAg‐positive HCC patients without cirrhosis (6%) or HBsAg‐positive controls (3%); thus, the conflicting results in the literature concerning the association of the HBeAg/anti‐HBe system with HCC may be accounted for, in part, by the variable association of HCC with an underlying cirrhosis.