ABSTRACT
Etiology Underlying chronic liver disease is present in the majority of patients presenting
with hepatocellular carcinoma (HCC). In general, any chronic injury to the liver can result in HCC, although the most established and important association has been with viral hepatitis. In the Far East, approximately 83% of patients with H CC have underlying cirrhosis, most commonly resulting from hepatitis B infection. Individuals who are seropositive for Hepatitis B surface antigen have at least a 100-fold increased risk of developing H CC compared to the general seronegative population. Although the carrier rate for HbsAg in the general Taiwanese population is 10%, 80% of Taiwanese patients with H CC are HbsAg positive. Even in areas where Hepatitis B infection is not endemic, there remains a strong association between H CC and Hepatitis B infection. For example in the United States, 23% of patients with HCC test seropositive for Hepatitis B, a figure which is approximately 6 times that of the general population. When HCC develops in association with cirrhosis in Western patients, it is more commonly a result o f Hepatitis C. Approximately 70% of cirrhotic patients with H CC in Japan and Southern Europe are seropositive for Hepatitis C, whereas in the United States, this figure is approximately 40-50%. It is thought that cirrhosis arising in the setting of Hepatitis C carries a greater risk of developing HCC. For patients with cirrhosis from Hepatitis B, the estimated risk is 0.5% per year. In contrast, the risk of developing H CC over a 10-year period in patients with Hepatitis C has been reported to be nearly 50%. In Western series,
Hepatobiliary Surgery, edited by Ronald S. Chamberlain and Leslie H. Blumgart. ©2003 Landes Bioscience.
