TMSS Medical College Journal

Background: The etiological agent of HCC is known in more than 90% of cases, in South East Asia, hepatitis B is the most common cause. In Bangladesh, HBsAg positivity in the healthy population is 5.4%. The relative risk (RR) of HCC is 100 in HBV carriers versus non - carriers. In HBV carriers with cirrhosis, the RR is 961 compared to uninfected controls. Cirrhosis is an almost invariable precursor to HCC, except in chronic hepatitis B. Objectives: To find out the relationship of cirrhosis with the development of hepatitis B-related hepatocellular carcinoma. Methods: This observational study was carried out in the Department of Hepatology, BSMMU from January 2012 to December 2013. The study was approved by the Ethical Institutional Review Board (IRB) of BSMMU, Dhaka. The diagnosis of HCC was confirmed by pathological examination or AFP elevation (400ng/ml) combined imaging (CT/MRI) and diagnosis of cirrhosis was made clinically on the basis history, clinical examination and laboratory investigations including imaging or pathological examination after exclusion of hepatitis C virus infection (Anti HCV+ve) and significant alcohol intake (>20 gm. /day). All patients were HBsAg positive done by ELISA test. Results: A total 44 patients were included in this study. Among them, 91% were male (n=40) and 09 % were female (n=4). The mean age was 48.2 (+12.9) years. Maximum (50%) patient's ages were belonged to 35-54 years. Cirrhosis was 79.5% (n=35) and no cirrhosis was found 20.5% (n=9). The difference was statistically significant (P = 0.001) among the two groups.Imaging finding of liver size showed hepatomegaly (74%), normal size (19%) and small liver (7%). Conclusions: From our observation we can conclude that cirrhosis is an independent risk factor for hepatitis B virus related HCC and also shows that inactive carriers are still at risk of HCC.

HCC is the sixth most common malignant tumor and the third most common cause of cancer deaths worldwide!. The etiological agent of HCC is known in more than 90% of cases. In South East Asia, hepatitis B is the most common underlying cause. The highest incidence of HCC is in Asia, accounting for about 76% of all cases worldwide?. HBV infection is a serious global health problem. About 378 million people throughout the world are chronically infected with this virus’. Approximately 15-40% of CHB patients will develop cirrhosis, liver failure and HCC. Bangladesh is within the intermediate zone of prevalence of HBV infection. HBsAg positivity in healthy population is 5.4%S. Beasley ef al, in a seminal prospective study, showed the relative risk (RR) of HCC to be about 100 in HBV carriers versus non- carriers. The yearly incidence of HCC in the HBV surface antigen (HBsAg) positive group was 0.5%, increasing to 1% by age 70. In HBV carriers with cirrhosis, the RR was 961 compared to uninfected controls, with an incidence of HCC of 2.5% per year. Cirrhosis is an almost invariable precursor to HCC, except in chronic hepatitis B. This has led to the concept that cirrhosis is a prencoplastic lesion or that cirrhosis is a common pathway by ‘which different liver diseases result in HCC. The common factor linking all liver discases with HCC would be the presence of repeated or persistent low - grade necrosis or cell injury, followed by regeneration, predisposing to an increased possibility of oncogenic mutations developing in actively dividing cells in damaged liver tissue’. Based on this hypothesis, we find out the relationship of cirrhosis and non-cirrhosis with the development of hepatitis B-related hepatocellular carcinoma