Hepatitis b virus and primary hepatocellular carcinoma

Primary hepatocellular carcinoma (PHC), although relatively uncommon in the United States and western countries, is one of the three most common causes of cancer mortality in the world, accounting for 250,000 to 1,000,000 deaths per year (1). In Taiwan, it is the leading cause of death for men over 40 years of age (30/100,000/yr at age 40 rising to 100/100,000/yr at age 60) (2). Even in the United States, there are about 5,000 deaths per year from PHC, giving an age-adjusted annual mortality of 2.2/100,000, which is three times that of Hodgkin's disease (0.7/100,000) (3). The incidence of PHC is essentially the same as the mortality, the five-year survival being in the 2-3 % range. Thus far, the only therapy that appears to improve survival is the resection of small (less than 3 cm in diameter) asymptomatic tumors (4).