Family History Is Important in Assessing HCC Risk in Chronic HBV Infection

Atif Zaman, MD, MPH

The risk is especially elevated with seropositivity for hepatitis B surface antigen and is further multiplied by hepatitis B e antigen positivity or a high viral DNA load.

Family history of hepatocellular carcinoma (HCC) has been reported as a risk factor for HCC in patients with hepatitis B virus (HBV) infection. However, the magnitude of the risk has not been well characterized.

The current study is a sub-study of a prospective, community-based cohort study (the REVEAL study) that examined the risk factors for HCC in 22,472 participants with and without viral hepatitis in 7 townships in Taiwan. Patients underwent routine visits and were followed for a mean of 16 years. HCC was identified through the national cancer registry.

During 362,268 person-years of follow-up, 374 cases of HCC were identified. Among hepatitis B surface antigen (HBsAg)–negative patients, the cumulative risk for HCC was similar between patients with and without a family history of HCC (0.65% and 0.62%, respectively). The cumulative risks were higher in patients with chronic HBV infection (HBsAg-positive), both with a family history of HCC (15.8%) and without (7.5%). In multivariate analysis, the adjusted hazard ratio for HCC in HBsAg-positive patients with a family history of HCC compared with HBsAg-negative patients without a family history was 32.3 (95% confidence interval, 20.8–50.3). Among HBsAg-positive patients, a family history of HCC, high viral level (≥10,000 copies/mL), and HBeAg-positivity showed a statistically significant and synergistic association with HCC risk.

Citation(s):

Loomba R et al. Synergistic effects of family history of hepatocellular carcinoma and hepatitis B virus infection on risk for incident hepatocellular carcinoma. Clin Gastroenterol Hepatol 2013 Dec; 11:1636.