title: Eight-year nationwide survival analysis in relatives of patients with hepatocellular carcinoma: role of viral infection.
abstract: BACKGROUND
  Families of patients with hepatocellular carcinoma (HCC) carry a high risk of developing HCC. We determine the number of fatalities in relatives of HCC patients during an 8-year period to understand the risk and cause of HCC in relatives of patients with HCC.
  
  
  METHODS
  From 1992 to 1997, 15 410 relatives of HCC patients in three generations were screened prospectively for HCC by ultrasonography, alpha-fetoprotein, liver biochemistry and viral markers. By using national citizen identification numbers, we searched the total fatalities in relatives of HCC patients between 1992 and 1999 from the national mortality data bank. The results were compared among different viral infection groups.
  
  
  RESULTS
  Of the relatives studied, 37.8% were hepatitis B s antigen (HBsAg) positive (+), 4.3% were anti-hepatitis C virus (HCV) (+) and 1.7% were both HBsAg (+) and anti-HCV (+). A total of 399 fatalities, including 139 because of HCC (34.8%), 37 because of liver diseases (9.3%), 88 because of other cancers (22.1%) and 135 because of other diseases (33.8%), were found. Relatives who were HBsAg (+) or anti-HCV (+)showed a lower cumulative survival than did relatives who were negative for both HBsAg and anti-HCV. Relatives with dual infection of hepatitis B and C virus showed the highest mortality due to HCC or terminal liver diseases.
  
  
  CONCLUSIONS
  Chronic viral infection rather than a hereditary factor is the main cause of a familial tendency for HCC. Dual infection of hepatitis B and C virus increases the risk of HCC or decompensated liver diseases.
authors.affiliation: Liver Research Unit, Chang Gung Memorial Hospital, Kaohsiung, Taiwan, ROC.
authors.forename: Dar-In
authors.initials: DI
authors.lastname: Tai
authors.forename: Chien-Hung
authors.initials: CH
authors.lastname: Chen
authors.forename: Ting-Tsung
authors.initials: TT
authors.lastname: Chang
authors.forename: Shinn-Cherng
authors.initials: SC
authors.lastname: Chen
authors.forename: Li-Ying
authors.initials: LY
authors.lastname: Liao
authors.forename: Chung-Huang
authors.initials: CH
authors.lastname: Kuo
authors.forename: Yang Yuan
authors.initials: YY
authors.lastname: Chen
authors.forename: Gran-Hum
authors.initials: GH
authors.lastname: Chen
authors.forename: Sien-Sing
authors.initials: SS
authors.lastname: Yang
authors.forename: Huang-Shang
authors.initials: HS
authors.lastname: Tang
authors.forename: Hsien Hong
authors.initials: HH
authors.lastname: Lin
authors.forename: Deng-Yn
authors.initials: DY
authors.lastname: Lin
authors.forename: Sing Kai
authors.initials: SK
authors.lastname: Lo
authors.forename: Jeng-Ming
authors.initials: JM
authors.lastname: Du
authors.forename: Kwo-Chuan
authors.initials: KC
authors.lastname: Lin
authors.forename: Chi-Sin
authors.initials: CS
authors.lastname: Changchien
authors.forename: Wen-Yu
authors.initials: WY
authors.lastname: Chang
authors.forename: Jin-Chuan
authors.initials: JC
authors.lastname: Sheu
authors.forename: Yun-Fan
authors.initials: YF
authors.lastname: Liaw
authors.forename: Ding-Shinn
authors.initials: DS
authors.lastname: Chen
authors.forename: Juei-Low
authors.initials: JL
authors.lastname: Sung
mesh_terms: D000328:Adult; D017677:Age Distribution; D006528:Carcinoma, Hepatocellular / Q000235:genetics* / Q000401:mortality / Q000821:virology; D005260:Female; D006509:Hepatitis B / Q000150:complications*; D006526:Hepatitis C / Q000150:complications*; D006801:Humans; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000235:genetics* / Q000401:mortality / Q000821:virology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D016019:Survival Analysis; D013624:Taiwan / Q000453:epidemiology