Presence of antibodies to the hepatitis B surface antigen is associated with an excess risk for hepatocellular carcinoma among non-Asians in Los Angeles County, California

✍ Scribed by M. C. Yu; J. Yuan; R. K. Ross; S. Govindarajan

• Publisher: John Wiley and Sons
• Year: 1997
• Tongue: English
• Weight: 125 KB
• Volume: 25
• Category: Article
• ISSN: 0270-9139
• DOI: 10.1002/hep.510250141

✦ Synopsis

Chronic infection by the hepatitis B virus (HBV) is a well-Hepatocellular carcinoma (HCC) exhibits a more than established risk factor for HCC. Previously, we have demon-50-fold variation in incidence worldwide. High-risk restrated that up to 90% of HCC cases among high-risk Chinese gions include East Asia and sub-Saharan Africa, while are HBV-related; in these endemic areas, the HBV carrier non-Asians in the United States constitute a low-risk rate can be as high as 20% to 25% among adult men. 2-4 As population. We assessed 111 cases of histologically conexpected, the HBV carrier rate is low among non-Asians in firmed HCC and 128 community control subjects among the United States, in the range of 1 per 1,000. 5 However, non-Asians of Los Angeles County for the presence in there is evidence that a substantial proportion of HCC paserum of hepatitis B surface antigen (HBsAg), antibodies tients in this low-risk population can be attributed to prior to HBsAg (anti-HBs), antibodies to the hepatitis B core HBV infection. In a small case-control study in Los Angeles antigen (anti-HBc), HBV DNA, and antibodies to the hepinvolving 51 non-Asian cases and 128 control subjects of comatitis C virus (anti-HCV). Anti-HCV positivity was signifiparable race, age, and sex distributions, we noted significantly associated with a 12.6-fold increase in HCC risk cantly increased risks for HCC in association with the pres-(95% confidence limits Å 4.7, 33.6). As expected, the presence of any of three serum markers of HBV infectionence of serum HBsAg and the presence of anti-HBc in hepatitis B surface antigen (HBsAg), antibodies to HBsAg the absence of anti-HBs were both positively associated (anti-HBs), and antibodies to the hepatitis B core antigen with the risk of HCC. But most interestingly, among our (anti-HBc). The risk for HCC among non-Asians positive for study subjects, the presence of anti-HBs in the absence any HBV markers relative to those who tested negative on of HBsAg and HBV DNA (indicative of a resolved infecall markers was estimated at 7.0, and the proportion of cases tion) was significantly related to a 4.7-fold increased risk attributable to prior HBV infection was estimated at 38%. 6 for HCC (95% confidence limits Å 2.2, 9.4). Overall, any

Ever since the isolation and cloning of the hepatitis C virus serological evidence of prior HBV exposure was associ-(HCV) by Choo et al., 7 a number of studies have implicated ated with a 9.4-fold elevation in HCC risk (95% confi-HCV infection as an important risk factor for HCC in diverse dence limits Å 4.7, 18.7). The data also demonstrate a populations, ranging from low-risk non-Asians in the United synergistic effect of HBV and HCV infections on the risk States, 6 to intermediate-risk Greeks 8 and Japanese, 9 to highof HCC. We estimate that about 55% of HCC cases ocrisk Africans. 10 In the Los Angeles study described above, we curring in non-Asians of Los Angeles can be attributed observed a 10.5-fold increased risk among non-Asians who to infection by the hepatitis B and/or C viruses. (HEPAtested positive for antibodies to HCV (anti-HCV) in serum TOLOGY 1997;25:226-228.)

relative to those who tested negative. We estimated that approximately 27% of non-Asian cases of HCC could be attrib-Hepatocellular carcinoma (HCC) is a malignancy that disuted to prior HCV infection. 6 At the time, legitimate concerns plays a wide range in incidence worldwide. High-risk regions were raised over the validity of our findings. 11 Our subjects include East Asia and sub-Saharan Africa. 1 In certain popuwere tested for anti-HCV using the first-generation enzymelations of south China, the age-standardized (world populalinked immunosorbent assay (ELISA) kits whose specificity tion) incidence rate in men is as high as 120 per 100,000 has been called into question (i.e., possibility of a high degree person-years. 2 In contrast, HCC is a relatively rare neoplasm of false positives). among non-Asians in the United States. In Los Angeles

As of May 1994, the number of HCC cases (whom we have County, the age-standardized incidence rates for primary continued to recruit) in our series has doubled to 111. We liver cancer in Hispanic white, black, and non-Hispanic white conducted a re-analysis of the hepatitis virus/HCC relationmen during 1983 to 1987 were 4.8, 6.1, and 2.3 per 100,000 ships using this larger data set to derive more stable estiperson-years, respectively. The corresponding rates in mates of risks, and to re-evaluate the possible association women were 1.7, 2.1, and 0.9 per 100,000 person-years. 1 between anti-HCV positivity and HCC risk in non-Asians of Los Angeles using the current standard method of HCV testing, i.e., ELISA version 2.0 with confirmation by RIBA version 2.0.

Abbreviations: HCC, hepatocellular carcinoma; HBV, hepatitis B virus; HBsAg, hepatitis B surface antigen; anti-HBs, antibodies to hepatitis B surface antigen; anti-HBc, antibodies to the hepatitis B core antigen; HCV, hepatitis C virus; anti-HCV, antibodies to hepatitis

PATIENTS AND METHODS

C virus; ELISA, enzyme-linked immunosorbent assay.