Predominant etiologic association of hepatitis C virus with hepatocellular carcinoma compared with hepatitis B virus in elderly patients in a hepatitis B‐endemic area

Abstract

It has been thought that the mean age of patients with hepatitis B surface antigen (HBsAg) positivity and hepatocellular carcinoma (HCC) is younger than that of patients who test positive for anti-hepatitis C virus. This study was to assess the relative etiologic association of hepatitis B virus (HBV) and hepatitis C virus (HCV) with HCC, according to age-specific groups. A total of 336 Korean patients with HCC were enrolled in the study; the mean age was 53.7 +/- 9.1 years, and the male-to-female ratio was 5.9. HBV serologic markers and anti-HCV were tested using commercially available radioimmunoassay and enzyme immunoassay kits, respectively. Two hundred thirty-three (69.3%) patients tested positive for HBsAg; anti-HCV was positive in 42.7% of 103 patients with HBsAg-negative disease and in 17.0% of all patients with HCC. Coinfection rate of HBV and HCV in the total number of patients with HCC was 3.9%. The mean age was 51.6 years for patients with HBsAg-positive disease and 60.4 years for patients with anti-HCV-positive disease. The ratio of HBsAg positivity compared with anti-HCV positivity in patients with HCC was 29.7 for patients younger than 50 years; 0.9 for patients older than 61 years; and 5.2 for patients in their 50s. The authors conclude that although HBV infection plays a more important etiologic role in the development of HCC in Korea than does HCV, HCV is no less frequently involved than HBV in the etiology of HCC for patients older than 61 years. Thus, in surveillance programs for the early detection of HCC, closer attention should be directed to the patients with anti-HCV-positivity and chronic liver disease, especially patients older than 61 years, even in a hepatitis-B-endemic area.