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Hepatitis B Virus, Aflatoxins, and Hepatocellular Carcinoma in Southern Guangxi, China¹

Department of Epidemiology, Guangxi Medical College, Nanning, Guangxi Autonomous Region, People's Republic of China [F-S. Y., C-C. M., S. L.]; Department of Preventive Medicine, University of Southern California School of Medicine, Los Angeles, California 90033 Y. [M. C. Y., B. E. H.]; and Liver Center; Huntington Memorial Hospital, Pasadena, California 91105 [M. J. T.]

We examined the roles of the hepatitis B virus and aflatoxin B₁ in the development of primary hepatocellular carcinoma (PHC) in a cohort of 7917 men aged 25 to 64 yr old in southern Guangxi, China, where the incidence of PHC is among the highest in the world. After accumulating 30,188 man-yr of observation, 149 deaths were observed, 76 (51%) of which were due to PHC. Ninety-one% (69 of 76) of PHC deaths were hepatitis B surface antigen (HBsAg) positive at enrollment into the study in contrast to 23% of all members of the cohort (RR=38.6). Three of the four patients who died of liver cirrhosis also were HBsAg positive at enrollment. There was no association between HBsAg positivity state and other causes of death. Within the cohort, there was a 3.5-fold difference in PHC mortality by place of residence. When estimated aflatoxin B₁ levels in the subpopulations were plotted against the corresponding mortality rates of PHC, a positive and almost perfectly linear relationship was observed. On the other hand, no significant association was observed when the prevalence of HBsAg positivity in the subpopulations was compared with their corresponding rates of PHC mortality.

¹ Supported by USPHS Grant CA00884 from the National Cancer Institute and by Grant SIG-2 from the American Cancer Society.

² To whom requests for reprints should be addressed.

Received 8/ 8/88. Revised 1/ 6/89. Accepted 2/ 1/89.

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