title: Clinical features of hepatocellular carcinoma seronegative for both HBsAg and anti-HCV antibody but positive for anti-HBc antibody in Japan.
abstract: OBJECTIVE
  We determined the prevalence of patients with hepatocellular carcinoma (HCC) who were positive for only anti-hepatitis B core (anti-HBc) antibody among 284 Japanese patients and compared their clinical features to those who were hepatitis B surface antigen positive [HBsAg(+)].
  
  
  METHODS
  Serum HBsAg and anti-hepatitis C virus (anti-HCV) antibody were examined for all HCC patients. Testing for anti-HBc antibody was performed in the HBsAg(-)/anti-HCV(-) patients. The clinical factors and the survival rate were compared between the HBsAg(+) patients (HCC-B) and those positive for anti-HBc alone (HCC-PB).
  
  
  RESULTS
  There were 19 (6.7%) HBsAg(+), 236 (83.1%) anti-HCV(+), seven (2.5%) HBsAg(+)/anti-HCV(+), and 22 (7.7%) HBsAg(-)/anti-HCV(-) among the 284 patients tested. Sixteen (72.7%) of the 22 HBsAg(-)/anti-HCV(-) patients were assigned to the HCC-PB group. The prevalence of positivity for anti-HBc alone among all 284 HCC patients was 5.6%. Significant differences between the HCC-PB and HCC-B groups were that age at diagnosis was higher in the HCC-PB group (72.1 yr) than in the HCC-B group (56.2 yr) (p < 0.001), the serum alpha-fetoprotein concentrations were lower in the HCC-PB group (8.2 ng/ml) than in the HCC-B group (43 ng/ml) (p = 0.0488), and a higher familial history of liver disease was observed in the HCC-B group (p = 0.0373). However, there was no significant difference in the cumulative survival rate.
  
  
  CONCLUSIONS
  Positivity for anti-HBc alone is not rare compared to HBsAg(+), and the clinical features of positivity for anti-HBc alone are similar to those of HBsAg(+). Some differences in the clinical features between the two groups may be explained by differences in the time of first exposure to hepatitis B virus. Therefore, the natural course of acute hepatitis B may be reconsidered.
authors.affiliation: Saga Social Insurance Hospital, Hyogo-minami, Saga-shi, Japan.
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Yano
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Yamashita
authors.forename: Shuji
authors.initials: S
authors.lastname: Sumie
authors.forename: Eiji
authors.initials: E
authors.lastname: Ando
authors.forename: Kazuta
authors.initials: K
authors.lastname: Fukumori
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kiyama
authors.forename: Takashi
authors.initials: T
authors.lastname: Oyama
authors.forename: Shigetaka
authors.initials: S
authors.lastname: Kuroki
authors.forename: Osamu
authors.initials: O
authors.lastname: Kato
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yamamoto
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Tanaka
authors.forename: Michio
authors.initials: M
authors.lastname: Sata
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology*; D018450:Disease Progression; D005260:Female; D006514:Hepatitis B Surface Antigens / Q000097:blood*; D018937:Hepatitis C Antibodies / Q000097:blood*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008113:Liver Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D016036:Seroepidemiologic Studies; D012698:Serologic Tests; D018709:Statistics, Nonparametric; D015996:Survival Rate
chemical_list: D006514:Hepatitis B Surface Antigens; D018937:Hepatitis C Antibodies