Eight-year nationwide survival analysis in relatives of patients with hepatocellular carcinoma: role of viral infection.
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.
Tai
Dar-In
DI
Liver Research Unit, Chang Gung Memorial Hospital, Kaohsiung, Taiwan, ROC.
Chen
Chien-Hung
CH
Chang
Ting-Tsung
TT
Chen
Shinn-Cherng
SC
Liao
Li-Ying
LY
Kuo
Chung-Huang
CH
Chen
Yang Yuan
YY
Chen
Gran-Hum
GH
Yang
Sien-Sing
SS
Tang
Huang-Shang
HS
Lin
Hsien Hong
HH
Lin
Deng-Yn
DY
Lo
Sing Kai
SK
Du
Jeng-Ming
JM
Lin
Kwo-Chuan
KC
Changchien
Chi-Sin
CS
Chang
Wen-Yu
WY
Sheu
Jin-Chuan
JC
Liaw
Yun-Fan
YF
Chen
Ding-Shinn
DS
Sung
Juei-Low
JL
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