The study of 226 cases of hepatocellular carcinoma (HCC) in a homogenous rural Southern African population is based on the assessment of histology, HBV infection, p53 oncoprotein and transforming growth factor alpha (TGFa) expression. Epidemiological and morphological observations were compared to HCC observed in 89 cases from pathological files in Poland and published information from Japan and Italy. Comparatively high number of young patients with HCC in Africa presented high rates of HBV infection, p53 oncoprotein overexpression and high HBsAg/p53 correlation rates. In all patients histological grading of HCC was inversely related to p53 and TGFa expression. No significant differences in histological grading of HCC and patients' mean age were noted between various population groups. The association of hepatic cirrhosis was at least twice as common in non-African patients, whereas iron overload was noted almost exclusively in African patients livers. Signs of HBV infection were lowest in Japanese female patients. The mechanism by which early HBV infection contributes to hepatocarcinogenesis at an early stage of life is confirmed by epidemiological observations in Poland and by the clear association of p53 gene with HBsAg and the age of patients.
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