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

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 less than 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 less than 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.