UICC World Cancer Congress 2006

Objective: Risk of developing hepatocellular carcinoma (HCC) in patients with chronic hepatitis B or hepatitis C are well described. However, the relation between the normal range of serum alanine aminotransferase level (ALT) and incidence of HCC is uncertain.

Methods: The subjects were selected from voluntary blood donors aged 40-64 years, having ALT levels below 30 Karumen Unit (KU) between 1991 and 1993. The eligible cases were 1318 hepatitis C virus (HCV) carries, 2277 hepatitis B virus (HBV) carriers and 142795 non-B, non-C individuals screened through voluntary blood donation. They were followed using the records at the Osaka Cancer Registry.

Results: During the mean 97 months of follow-up, 53 subjects developed HCC. The average annual incidence rate (per 10⁵ person-years) by ALT levels (9KU ≥, 10-19KU, 20-29KU) were: 25, 63, 534 in HBV carriers, 0, 32, 176 in HCV carriers and 1.3, 0.7, 6.3 in non-B, non-C individuals, respectively. Multivariate Cox proportional hazard analysis showed that HBV carriers and HCV carriers had significantly higher risk of developing HCC than non-B, non-C individuals even though they had normal ALT levels (rate ratio: 72 and 22, respectively). People having normal ALT levels without HBV nor HCV infection have a negligible risk on developing HCC.