Hepatitis B surface antigen, hepatocellular carcinoma and cirrhosis in hong kong: a necropsy study: 1963-1976

Hepatitis B surface antigen (HBsAg) was stained in liver tissue in 71% of 496 cases of cirrhosis with and without hepatocellular carcinoma (HCC) in Chinese coming to necropsy in Hong Kong from 1963-1976. Male cases numbered 417; HBsAg was positive in 83% of those in which HCC was combined with cirrhosis and in 62% of those with cirrhosis alone. Of 39 additional male cases of HCC without cirrhosis, 38% were HBsAg+. Similar proportions were recorded in the famale cases. This progression suggests a cumulative carcinogenic effect of persistent hepatitis B virus (HBV) fully expressed in the presence of cirrhosis. The approximate risk factors for males in Hong Kong who are HBsAg+ at the time of death, compared with HBsAg- males, are 6:1 for HCC alone, 16:1 for cirrhosis alone and 50:1 for HCC combined with cirrhosis. The frequency of HBsAg+ tests is much higher in Hong Kong than in the United Kingdom, and cirrhosis is calculated to be 2.8 times and HCC 11 times commoner. The high incidence of HCC in Hong Kong is not attributable solely to the high incidence of cirrhosis, but can be related to the high incidence of cirrhosis accompanied by persistent HBV.