OBJECTIVETo explore the relationship between polycyclic aromatic hydrocarbon (PAH) exposure and hepatocellular carcinoma (HCC), and the interaction of PAH exposure and other HCC risk factors to HCC.

METHODSBaseline blood samples, collected from 345 HCC cases and 961 controls, were used to determine the level of PAH-albumin adducts by competitive enzyme-linked immunosorbent assay. Conditional logistic regression analysis was used to assess the effect of PAH-albumin adducts on risk of HCC.

RESULTSThe mean level of PAH-albumin adducts was significantly higher in cases than in controls ((5.68 +/- 0.72) fmol/mg albumin vs (5.46 +/- 0.63) fmol/mg albumin) (u = 5.98, P < 0.01). When compared to subjects in the lowest quantile (< 1.76 fmol/mg albumin), there was an increase in risk of HCC, with adjusted ORs (95%CI) of 1.03 (0.65 - 1.60), 1.18 (0.76 - 1.78), 2.01 (1.42 - 2.82) for subjects in the second (1.76-fmol/mg albumin), the third (15.28-fmol/mg albumin), and the fourth quantile (> 34.21 fmol/mg albumin), respectively (chi(2)(trend) = 15.06, P < 0.01). There was a significant interaction between PAH-albumin adducts and HBsAg, family history of cancer and diabetes mellitus on HCC after adjusted for other risk factors, and relative excess risks due to the interaction (RERI) were 2.50 (u = 3.60, P < 0.01), 0.52 (u = 2.13, P < 0.05) and 0.88 (u = 2.26, P < 0.05), respectively.

CONCLUSIONPAH-albumin adducts was related with HCC, and there is a trend of HCC prevalence increasing with the content of PAH-albumin adducts. There are interactions between PAH-albumin adducts and HBV infection, family history of cancer and diabetes mellitus on HCC.

Adult ; Aflatoxins ; blood ; Aged ; Carcinoma, Hepatocellular ; blood ; epidemiology ; Case-Control Studies ; Causality ; Female ; Humans ; Liver Neoplasms ; blood ; epidemiology ; Male ; Middle Aged ; Polycyclic Aromatic Hydrocarbons ; blood ; Prevalence ; Risk Factors

OBJECTIVETo survey the levels of Golgi glycoprotein (GP73), a hepatocellular carcinoma (HCC) marker, in residents of Qidong and determine the correlation of detected GP73 concentration ranges with outcome at two-year follow-up.

METHODSA total of 12,378 individuals (age range: 35-69 years old) from Qidong were enrolled in the study. All participants were tested for hepatitis B virus (HBV) by detecting hepatitis B surface antigen (HBsAg) in serum. One-tenth of the participants were assigned to a stratified-random sample group (those with identification numbers ending with "0") to represent a "subgroup of the natural population" (HBsAgPop, n = 1227). All HBsAg carriers were stratified as a "subgroup of positivity" (HBsAgPve, n = 1025). One-tenth of all HBsAg-negative individuals were assigned to a stratified-random sample group to represent a "subgroup of negativity" (HBsAgNve, n = 1132). Enzyme-linked immunoassay was used to measure the serum GP73 and alpha-fetoprotein (AFP) levels; the distribution, medians (50th percentile), and 95th percentiles of GP73 were determined for the three subgroups. A two-year follow-up was carried out to observe the differential incidence of HCC between the HBsAgPve and HBsAgNve subgroups.

RESULTSA positively skewed distribution of the GP73 values was observed for all three subgroups. The medians for HBsAgPve, HBsAgNve, and HBsAgPop were 67 mug/L, 54 mug/L, and 55 mug/L; the 95th percentiles were 174 mug/L, 108 mug/L, and 114 mug/L, respectively. The AFP positivity rates were 7.23% (37/512) for carriers whose GP73 values were above the median level and 0.78% (4/513) for carriers with GP73 values below the median level, with a highly significant difference between the two (P less than 0.01). A the two-year follow-up, 23 (4.49%) of the 512 carriers with GP73 more than or equal to 67 mug/L had developed HCC, while only one patient (0.19%) of the 513 carriers with GP73 less than 67 mug/L developed HCC, which yielded a relative risk value of 23.6. In the non-carriers, no HCC cases had occurred, regardless of serum GP73 level.

CONCLUSIONSerum GP73 has a higher potential as a diagnostic/prognostic marker of HCC in individuals with HBsAg positivity. In follow-up of HBsAg carriers, GP73 may help in the early detection of liver cancer.

Adult ; Aged ; Biomarkers ; blood ; Carcinoma, Hepatocellular ; epidemiology ; Carrier State ; China ; epidemiology ; Female ; Follow-Up Studies ; Hepatitis B Surface Antigens ; blood ; Hepatitis B, Chronic ; blood ; epidemiology ; Humans ; Liver Neoplasms ; epidemiology ; Male ; Membrane Proteins ; blood ; Middle Aged

Sometimes, hepatitis B virus (HBV)-related cirrhotic patients with normal aminotransferase levels are closely followed-up for the elevation of aminotransferase levels instead of prompt antiviral therapy (AVT). We analyzed the long-term hepatocellular carcinoma (HCC) risk according to the aminotransferase levels in a retrospective cohort of 1,468 treatment-naive, HBV-related, compensated cirrhosis patients with elevated HBV DNA levels (> or =2,000 IU/mL). Based on aminotransferase levels, patients were categorized into normal (< 40 U/L, n = 364) and elevated group (> or =40 U/L, n = 1,104). During a median of 5.3 yr of follow-up (range: 1.0-8.2 yr), HCC developed in 296 (20%) patients. The 5-yr cumulative HCC incidence rate was higher in patients with elevated aminotransferase level, but was not low in normal aminotransferase level (17% vs. 14%, P = 0.004). During the follow-up, 270/364 (74%) patients with normal aminotransferase levels experienced elevation of aminotransferase levels, and AVT was initiated in 1,258 (86%) patients. Less patients with normal aminotransferase levels received AVT (70% vs. 91%, P < 0.001) and median time to start AVT was longer (17.9 vs. 2.4 months, P < 0.001). AVT duration was an independent factor associated with HCC, and median duration of AVT was shorter (4.0 vs. 2.6 yr, P < 0.001) in patients with normal aminotransferase levels. The HCC risk of compensated cirrhosis patients with normal aminotransferase level is not low, and AVT duration is associated with lowered HCC risk, indicating that prompt AVT should be strongly considered even for those with normal aminotransferase levels.
Alanine Transaminase/*blood ; Biomarkers/blood ; Carcinoma, Hepatocellular/*blood/*epidemiology ; Causality ; Comorbidity ; DNA, Viral/blood ; Female ; Hepatitis B/blood/*epidemiology ; Hepatitis B virus/genetics ; Humans ; Incidence ; Liver Cirrhosis/blood/drug therapy/epidemiology ; Liver Neoplasms/*blood/*epidemiology ; Male ; Middle Aged ; Reproducibility of Results ; Republic of Korea/epidemiology ; Risk Factors ; Sensitivity and Specificity

Adult ; Carcinoma, Hepatocellular ; epidemiology ; pathology ; virology ; DNA, Viral ; blood ; genetics ; Female ; Genotype ; Hepatitis B ; epidemiology ; virology ; Hepatitis B Surface Antigens ; blood ; Hepatitis B virus ; genetics ; Humans ; Liver Neoplasms ; epidemiology ; pathology ; virology ; Male ; Middle Aged ; Neoplasm Staging ; Polymerase Chain Reaction ; methods

Because Mongolia has much higher liver disease burden than any other regions of the world, it is necessary to provide information on real-time situation of chronic liver disease in Mongolia. In this article, we reviewed studies performed in Mongolia from 2000 to 2011 on seroprevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) among healthy individuals and patients with chronic liver diseases, and on the practice patterns for the management of liver cirrhosis and hepatocellular carcinoma (HCC). According to previous reports, the seroprevalence of HBV and HCV in general population in Mongolia is very high (11.8% and 15% for HBV and HCV, respectively). Liver cirrhosis is also highly prevalent, and mortality from liver cirrhosis remained high for the past decade (about 30 deaths per 100,000 populations per year). Among patients with cirrhosis, 40% and 39% are positive for HBsAg and anti-HCV, respectively, and 20% are positive for both. The seroprevalence is similar for HCC and more than 90% of HCC patients are positive for either HBV or HCV. The incidence of HCC in Mongolia is currently among the highest in the world. The mortality from HCC is also very high (52.2 deaths per 100,000 persons per year in 2010). Partly due to the lack of established surveillance systems, most cases of HCC are diagnosed at an advanced stage. The mortality from liver cirrhosis and HCC in Mongolia may be reduced by implementation of antiviral therapy program and control of alcohol consumption.
Carcinoma, Hepatocellular/blood/diagnosis/*epidemiology/mortality/therapy ; Hepatitis B, Chronic/epidemiology ; Hepatitis C, Chronic/epidemiology ; Humans ; Liver Cirrhosis/epidemiology ; Liver Diseases/blood/diagnosis/*epidemiology/mortality/therapy ; Liver Neoplasms/blood/diagnosis/*epidemiology/mortality/therapy ; Mongolia/epidemiology ; Prevalence ; Prognosis ; Risk Assessment ; Risk Factors ; Seroepidemiologic Studies ; Time Factors

OBJECTIVER0 resection, Pringle maneuver, intraoperative massive blood loss and perioperative blood transfusion have been definitely recognized to be surgery-related risk factors of recurrence of hepatocellular carcinoma (HCC) in recent years. The aim of this study was to investigate the post-operative risk factors of recurrence of HCC after control of the above mentioned risk factors.

METHODS288 consecutive HCC patients underwent hepatectomy with selective regional vascular occlusion by the same surgical team. All patients had R0 resection, less than 800 ml blood loss and had no perioperative blood transfusion. The clinical and pathological factors were retrospectively analyzed.

RESULTSThe total 1-year, 3-year and 5-year disease-free survival rate (DFS) was 74.9%, 49.3% and 34.3%, respectively. Univariate analysis showed that serum gamma-glutamyl-transferase rise >55 U/L, AFP > 400 ng/ml, tumor diameter >5 cm, multi-focal lesions, satellite nodules, poor differentiation, microvascular invasion, envelope invasion, postoperative liver insufficiency, preoperative TACE and postoperative TACE were significantly associated with poor DFS. Multivariate Cox analyses revealed that tumor size, satellite nodules, poor differentiation, microvascular invasion and postoperative liver insufficiency were independent prognostic predictors associated with shorter DFS. According to the results of multivariate Cox analysis of 158 cases with at least one risk factor selected from the whole group, further analysis demonstrated that perioperative TACE was not significantly associated with the median DFS (P > 0.05 for all).

CONCLUSIONSSelective regional vascular occlusion may effectively control the surgiury-related risk factors of recurrence of HCC. Tumor features are the main affecting factors of DFS. Preoperative or postoperative TACE do not benefit patients who received curative resection.

Blood Loss, Surgical ; Carcinoma, Hepatocellular ; epidemiology ; surgery ; Disease-Free Survival ; Hepatectomy ; Humans ; Liver Neoplasms ; epidemiology ; surgery ; Multivariate Analysis ; Neoplasm Recurrence, Local ; epidemiology ; surgery ; Postoperative Period ; Prognosis ; Retrospective Studies ; Risk Factors

OBJECTIVETo describe and compare the hepatitis virus infection in hepatocellular carcinoma (HCC) patients receiving surgical operation in China and Japan.

METHODSInformation of surgical HCC patients was retrieved from the medical records. The concerned characteristics of the HCC cases from two countries were described and compared.

RESULTSA total of 425 diagnosed cases that underwent surgical resection for HCC in China were investigated, and the corresponding cases in Japan were 247. The proportion of the hepatitis virus infection was 75.53% in patients with HCC from China. Within the infection cases, 91.28% were positive for HBsAg but negative for anti-HCV. The proportion was 82.59% in patients with HCC from Japan. Within the infection cases, 77.94% were positive for anti-HCV but negative for HBsAg. The proportion of hepatocirrhosis in the hepatitis virus infection patients with HCC were 89.10% and 68.14% in China and Japan, respectively.

CONCLUSIONThe hepatitis B virus infection showed be a main cause of HCC in China, however, the HCC in Japan be mostly related to hepatitis C virus infection.

Adolescent ; Adult ; Age Distribution ; Aged ; Aged, 80 and over ; Carcinoma, Hepatocellular ; epidemiology ; surgery ; virology ; Child ; China ; epidemiology ; Female ; Hepacivirus ; immunology ; Hepatitis B ; epidemiology ; virology ; Hepatitis B Surface Antigens ; blood ; Hepatitis B virus ; immunology ; Hepatitis C ; epidemiology ; virology ; Hepatitis C Antigens ; blood ; Humans ; Japan ; epidemiology ; Liver Neoplasms ; epidemiology ; surgery ; virology ; Male ; Middle Aged ; Sex Distribution ; Young Adult

BACKGROUND/AIMS: Many patients are diagnosed with cryptogenic hepatocellular carcinoma (HCC) without metabolic syndrome (MS). We investigated the risk factors for cryptogenic HCC in patients with a low body mass index (BMI) or without MS. METHODS: Thirty-six patients were diagnosed with cryptogenic HCC over a 10-year period at a tertiary research hospital. Data including BMI score and risk factors for MS were analyzed retrospectively. Patients with fewer than two risk factors for MS (n = 16) were compared with those with two or more risk factors (n = 20). Patients with high BMI (> or = 23 kg/m2, n = 20) were also compared with those with lower BMI (n = 16). RESULTS: Patients with fewer than two risk factors for MS were significantly more likely to smoke and be hepatitis B surface antibodies (anti-HBs)-positive vs. patients with two or more risk factors. However, only smoking was statistically significant on multivariate analysis. Peaks of BMI were observed in two regions. Lower BMI was significantly associated with the presence of anti-HBs compared with high BMI, although this association was not statistically significant on multivariate analysis. CONCLUSIONS: Smoking is a potential risk factor for cryptogenic HCC in patients without MS. Remote hepatitis B virus infection may be a risk factor for cryptogenic HCC in patients without MS or with a low BMI.
Aged ; Aged, 80 and over ; *Body Mass Index ; Carcinoma, Hepatocellular/*epidemiology ; Chi-Square Distribution ; Female ; Hepatitis B/diagnosis/epidemiology ; Hepatitis B Antibodies/blood ; Hepatitis B Surface Antigens/immunology ; Humans ; Liver Neoplasms/*epidemiology ; Logistic Models ; Male ; Metabolic Syndrome X/*epidemiology ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Republic of Korea/epidemiology ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Smoking/adverse effects/epidemiology ; Time Factors

OBJECTIVETo determine the relationship between the serum hepatitis B virus (HBV) DNA and the risk of primary liver cancer (PLC).

METHODSFarmers aged 30 to 55 years in Long An county were recruited in this study Blood samples were collected and the sera were tested for HBsAg using Enzyme-Linked ImmunoSorbent Assay (ELISA), and the HBsAg-positive sera were further tested for viral DNA using nested polymerase chain reaction (nPCR). The study subjects were divided into three groups. The first group was positive for both HBsAg and HBV DNA. The second group was positive for HBsAg but negative for HBV DNA. Age-, sex-, residence-matched HBsAg negative controls for group 1 and group 2 were enrolled in the third group. The cohort was followed up for four years.

RESULTSThe positive rate of HBsAg in these farmers was 14.52% (3975/27,379), and the HBV DNA positive rate in HBsAg positive subjects was 40.35% (1604/3975). The total PLC incidence rate in Group 1 and 2 was 672.45 /100,000 person-years (PY), significantly higher than that in Group3 (17.19 /100,000 PY). The relative risk (RR) was 39.123, and the 95% confidence interval (CI) was 9.018-159.146. The PLC incidence rate of Group 1 (984.03/100,000 PY) was significantly higher than that of Group2 (324.38 /100,000 PY). The RR was 3.034, and the 95% CI was 1.795-5.125. Multivariate analyses of Group1 and 2 with Cox model showed that sex, age, serum HBV DNA, and family history of PLC were independent risk factors of PLC.

CONCLUSIONHBV DNA and HBsAg positive subjects have a higher chance to develop PLC than HBV DNA negative-, HBsAg positive subjects.

Adult ; Carcinoma, Hepatocellular ; epidemiology ; virology ; China ; epidemiology ; DNA, Viral ; blood ; Female ; Follow-Up Studies ; Hepatitis B ; complications ; Hepatitis B Surface Antigens ; blood ; Hepatitis B virus ; genetics ; isolation & purification ; Humans ; Liver Neoplasms ; epidemiology ; virology ; Male ; Middle Aged ; Polymerase Chain Reaction ; Prospective Studies ; Risk Factors ; Viral Load ; Young Adult

BACKGROUND/AIMS: Whether alcohol intake increases the risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B virus (HBV) infection remains controversial. The aim of this study was to determine the effect of alcohol intake on the development of HCC. METHODS: Between January 2006 and August 2008, 146 patients with an initial diagnosis of HCC who were hospitalized in 3 major hospitals in the Incheon area were enrolled as cases. Another 146 cirrhotic patients, who matched the cases by age and sex, were enrolled as controls. All cases and controls were HBsAg positive, and had a history of lifetime alcohol intake. RESULTS: The cases and controls were aged 53+/-8 and 53+/-9 years (mean+/-SD), respectively, with each group comprising 118 males and 28 females. The basal laboratory data, distribution of Child-Pugh class, HBeAg positivity (31.5% vs. 37.7%), HBV DNA level (5.74+/-2.35 vs. 5.98+/-2.29 log(10) copies/mL), and proportion with a lifetime alcohol intake of more than 292 kg (30.8% vs. 34.9%) did not differ between cases and controls. The cumulative alcohol intake and the proportion of heavy drinkers did not differ between the two groups in male patients. CONCLUSIONS: Alcohol intake might not increase the risk of HCC in patients with HBV infection.
Adult ; Alcohol Drinking/*adverse effects ; Carcinoma, Hepatocellular/epidemiology/*etiology ; Case-Control Studies ; Cross-Sectional Studies ; DNA, Viral/blood ; Female ; Hepatitis B Surface Antigens/blood ; Hepatitis B, Chronic/*complications ; Humans ; Liver Cirrhosis/*complications/epidemiology ; Liver Neoplasms/epidemiology/*etiology ; Male ; Middle Aged ; Risk Factors