Relative risk of hepatocellular carcinoma in HBsAg positive vs alcoholic cirrhosis. A cross-sectional study.

The etiological link between hepatitis B virus (HBV) infection and hepatocellular carcinoma (HCC) has been suggested on epidemiologic, serologic and molecular grounds. This link has, however, recently been questioned by prospective studies suggesting that HBV infection also causes cirrhosis and that whatever the cause of cirrhosis, the risk of developing HCC could be roughly similar. All male patients first admitted to Hôpital Beaujon with cirrhosis or HCC from 1983 to 1987 were included in a cross-sectional study. A total of 277 new patients with cirrhosis (but free of HCC) were admitted, of whom 55 were HBsAg positive, and 181 were alcoholic. During the same period, 117 new patients with HCC were admitted, 48 in association with alcoholic cirrhosis, 36 with HBsAg positive cirrhosis. The relative risk (odds ratio) of HCC was 2.5 (95% confidence interval, 1.46-4.37; p = 0.0011) in patients with HBsAg positive cirrhosis as compared to patients with alcoholic cirrhosis. HBsAg positive patients were significantly younger than their alcoholic counterparts (48 +/- 14 vs 54 +/- 10 years in the cirrhotic group; 49 +/- 12 vs 62 +/- 8 years in the HCC group). We conclude that, using the methodology of a cross-sectional study, the relative risk of HCC was about twice greater in HBV-associated than alcoholic cirrhosis. The results of longitudinal prospective studies examining this issue might be biased by selecting patients older than the mean age of HCC occurrence or excluding patients with HCC when present at first admission.