The value of hepatitis B x antigen as a prognostic marker in the development of hepatocellular carcinoma.

Chronic infection with hepatitis-B virus (HBV) is associated with high risk for the development of hepatocellular carcinoma (HCC). Several studies have implicated that the X gene product(s) of HBV are important to the pathogenesis of HCC. This study tests the hypothesis that immunohistochemical detection of hepatitis B x antigen (HBxAg) is closely associated with HCC. The patterns of HBxAg were determined by staining in tumor and non-tumor liver sections from 30 Chinese patients with HBV-associated HCC, and the results were compared with other markers of infection. HBxAg was the most prevalent marker of HBV infection both in tumor and in non-tumor tissues of HCC patients, as compared with the hepatitis-B surface and core antigens. This pattern was observed among carriers as well as several patients who were HBsAG- in serum. The HBxAg staining results were validated by Southern blotting with an X-region probe and by Western blotting with anti-HBx. These results suggest that the persistence of HBxAg is important to the pathogenesis of early HCC and that HBxAg expression in the liver during chronic HBV infection may be an important prognostic marker for the development of HCC.