Progression of hepatitis B and C to hepatocellular carcinoma in Western countries.

Hepatitis B virus (HBV) and hepatitis C virus (HCV) are major causes of chronic liver disease and hepatocellular carcinoma (HCC) worldwide. In Western countries most HCC associated with HBV or HCV infection occurs in the cirrhotic liver. In a longitudinal studies of series of a Caucasian patients with compensated cirrhosis the incidence of HCC was approximately 2 and 2.5 per 100 person-years for HBV-related and HCV-related cirrhosis, respectively. The host factors of age, age at infection and male sex as well as parameters reflecting the severity of liver disease, such as bilirubin and platelets, appear to be significant predictors of liver cancer in patients with cirrhosis. It is still controversial whether HCV genotype 1b has a specific oncogenic potential. Studies from Europe have shown a low risk for HCC in patients with compensated cirrhosis type B who achieve a sustained virological and disease remission. Overall these data strengthen the epidemiological evidence of the association among HBV infection, cirrhosis and HCC in the West, indicating a similar risk for liver cancer in Caucasian patients with cirrhosis type B or C and suggest that tumors occur mainly in patients with long-standing disease. Additional factors that may promote liver cancer include concurrent HBV and HCV infection (approximately 5 fold-increase in risk) or concomitant heavy alcohol intake (synergism).