alcoholic liver disease, and most probably nonalcoholic fatty liver disease. Less common
causes include hereditary hemochromatosis, alpha1-antitrypsin deficiency, autoimmune
hepatitis, some porphyrias, and Wilson’s disease. The distribution of these
risk factors among patients with hepatocellular carcinoma is highly variable, depending
on geographic region and race or ethnic group.5 Most of these risk factors lead to
the formation and progression of cirrhosis, which is present in 80 to 90% of patients
with hepatocellular carcinoma. The 5-year cumulative risk for the development of
hepatocellular carcinoma in patients with cirrhosis ranges between 5% and 30%, depending
on the cause (with the highest risk among those infected with HCV), region
or ethnic group (17% in the United States and 30% in Japan), and stage of cirrhosis
(with the highest risk among patients with decompensated disease).6
Worldwide, chronic HBV infection accounts for approximately 50% of all cases
of hepatocellular carcinoma and virtually all childhood cases. In endemic areas in
Asia and Africa, where HBV infection is transmitted from mother to newborn, up
to 90% of infected persons have a chronic course, with frequent integration of HBV
into host DNA. Although HBV can cause hepatocellular carcinoma in the absence
of cirrhosis, the majority (70 to 80%) of patients with HBV-related hepatocellular
carcinoma have cirrhosis. The risk of hepatocellular carcinoma among persons with
chronic HBV infection (those who are positive for the hepatitis B surface antigen
[HBsAg]) is further increased if they are male or elderly, have been infected for a
long time, have a family history of hepatocellular carcinoma, have been exposed to
the mycotoxin aflatoxin, have used alcohol or tobacco, are coinfected with HCV or
hepatitis delta virus, have high levels of HBV hepatocellular replication (as indicated
alcoholic liver disease, and most probably nonalcoholic fatty liver disease. Less commoncauses include hereditary hemochromatosis, alpha1-antitrypsin deficiency, autoimmunehepatitis, some porphyrias, and Wilson’s disease. The distribution of theserisk factors among patients with hepatocellular carcinoma is highly variable, dependingon geographic region and race or ethnic group.5 Most of these risk factors lead tothe formation and progression of cirrhosis, which is present in 80 to 90% of patientswith hepatocellular carcinoma. The 5-year cumulative risk for the development ofhepatocellular carcinoma in patients with cirrhosis ranges between 5% and 30%, dependingon the cause (with the highest risk among those infected with HCV), regionor ethnic group (17% in the United States and 30% in Japan), and stage of cirrhosis(with the highest risk among patients with decompensated disease).6Worldwide, chronic HBV infection accounts for approximately 50% of all casesof hepatocellular carcinoma and virtually all childhood cases. In endemic areas inAsia and Africa, where HBV infection is transmitted from mother to newborn, upto 90% of infected persons have a chronic course, with frequent integration of HBVinto host DNA. Although HBV can cause hepatocellular carcinoma in the absenceof cirrhosis, the majority (70 to 80%) of patients with HBV-related hepatocellularcarcinoma have cirrhosis. The risk of hepatocellular carcinoma among persons withchronic HBV infection (those who are positive for the hepatitis B surface antigen[HBsAg]) is further increased if they are male or elderly, have been infected for along time, have a family history of hepatocellular carcinoma, have been exposed tothe mycotoxin aflatoxin, have used alcohol or tobacco, are coinfected with HCV orhepatitis delta virus, have high levels of HBV hepatocellular replication (as indicated
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