Factors determining the development of hepatocellular carcinoma in hepatitis B surface antigen carriers. A comparison between families with clusters and solitary cases

This article documents five families with clusters of hepatocellular carcinoma (HCC), including one in which three successive generations were involved. All the 12 patients in these five families and 96.3% of the patients in 54 families with solitary cases of HCC seen during the same period were hepatitis B surface antigen (HBsAg)-positive. The prevalence of HBsAg in families with clusters and solitary cases of HCC was compared. The clustering of HCC in the five families reported could not be accounted for by a higher HBsAg carrier rate or an earlier age of onset of the hepatitis B virus infection. An attempt was made to identify the factors that determine the development of HCC in HBsAg carriers.