Large heterogeneity exists in the relative importance of hepatitis B virus (HBV) and hepatitis C virus (HCV) in hepatocellular carcinoma (HCC) aetiology worldwide, but the evidence has never been compiled systematically for the entire globe. Methods Case-series or case-control studies of HCC reporting prevalence of hepatitis B surface antigen (HBsAg) and antibodies against HCV (anti-HCV, excluding first-generation assays), both alone and in combination, for at least 20 HCC cases were identified. Prevalence estimates were calculated separately for countries with information on at least 150 HCC cases, or were combined for lesser studied countries from the same continent. Findings A total of 28,292 HCC cases from 36 countries met the inclusion criteria. A predominance of HBsAg over anti-HCV seropositivity was found in HCC cases from most Asian, African and Latin American countries, but anti-HCV seropositivity predominated in Japan, Pakistan, Mongolia, and Egypt. In China anti-HCV was found more often in combination with HBsAg than alone. A clear predominance of anti-HCV over HBsAg seropositivity was seen in Europe and the United States. More than half of HCC cases in Sweden and the United States were negative for both markers. Interpretation Our findings suggest that in the last two decades HCV has caused more HCC cases than HBV in developed countries, but it has also contributed substantially to the HCC burden in some developing countries in Asia, where the fraction of HCC attributable to HCV may be on the rise.

98th AACR Annual Meeting-- Apr 14-18, 2007; Los Angeles, CA