title: Silent cirrhosis in hepatitis B virus related hepatocellular carcinoma.
abstract: OBJECTIVE
  Prevalence of hepatitis B virus (HBV) related cirrhosis and hepatocellular carcinoma (HCC) is high in Saudi Arabia. However, thee relationship between these two presentations is not well studied.
  
  
  METHODS
  Medical charts of 170 Saudi HBV patients (70 with HCC and 100 with cirrhosis without HCC) were reviewed.
  
  
  RESULTS
  Patients with HCC at presentation were older compared to those with cirrhosis without HCC at presentation (60.9 y vs. 51.2 y; p<0.05). Right upper quadrant pain (p<0.001) and hepatic bruit (p<0.0001) independently predicted the presence of HCC. Cirrhosis, present in 76% of HCC patients, remained silent and only 4% (3 of 73) of all HCC cases had clinical manifest cirrhosis. Cirrhotics without HCC at presentation developed HCC at the rate of 0.67% per 100 person years follow up.
  
  
  CONCLUSIONS
  Liver cirrhosis and HCC are distinct presentations of HBV in Saudi Arabia. Majority of patients with HCC at presentation have silent cirrhosis. Rate of development of HCC in patients with HBV related cirrhosis is low.
authors.affiliation: Division of Gastroenterology, Department of Medicine, King Fahd Central Hospital, Gizan, Saudi Arabia. ashwanisingal.com@gmail.com
authors.forename: Ashwani K
authors.initials: AK
authors.lastname: Singal
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000209:etiology*; D005260:Female; D006509:Hepatitis B / Q000150:complications*; D006801:Humans; D008103:Liver Cirrhosis / Q000209:etiology*; D008113:Liver Neoplasms / Q000209:etiology*; D008297:Male; D008875:Middle Aged