The risk factor of hepatitis B virus associated hepatocellular carcinoma in pediatric patients

T Sogo MD, T Fujisawa MD, A Inui MD, N Shiki MD, H Komatsu MD, I Sekine MD

National Defense Medical College, Tokorozawa, Saitama Japan

AIM: We investigated the risk factor of HBV related hepatocellular carcinoma in adolescents or young adults. Methods: 116 patients in the age of 0 to 20 years who were positive for hepatitis B surface antigen in serum for at least 2 years were enrolled in this study. The subjects were followed up longitudinally for 2 to 29 years. Serum HBV DNA was quantitated by a commercial kit (DNA probe Chugai-HBV, Chugai Diagnostics, Tokyo) in 39 of the patients. HBV genotype was determined by PCR-RFLP in 20 of the patients. Results: At the end of follow-up, 17 patients (15%) were HBe-Ag positive asymptomatic carriers, 21 (19%) were HBe-Ag positive chronic hepatitis, 4 (3%) were anti-HBe Ab positive chronic hepatitis, 70 (60%) were anti-HBe Ab positive asymptomatic carriers and 3 (2%) were hepatocellular carcinoma. Three patients with hepatocellular carcinoma were all genotype C and anti-HBe Ab positive HBV carrier. In two of them, transaminase levels were still abnormal after converted to anti-HBe Ab positive phase and the HBV DNA levels were > 3.7LGE/mL. Hepatocellular carcinoma was more frequently seen in patients with both abnormal transaminase levels, anti- HBe Ab positive phase and high HBV levels (2 of 10 patients) than those with both normal transaminase levels, anti-HBe Ab positive phase and low HBV levels (none of 26 patients). Conclusions: All children carrying hepatitis B surface antigen should be observed carefully to monitor the possible development of hepatocellular carcinoma, especially in the anti-HBe positive phase with abnormal transaminase levels and high HBV DNA levels.

KEY WORDS: genotype, serum hepatitis B virus DNA level, serum transaminase level, anti-hepatitis B e antibody.

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Paper presented at the International Symposium on Predictive Oncology and Intervention Strategies; Paris, France; February 9 - 12, 2002; in the section on Risk Assessment, Part 1.