Two polymorphisms in the promoter region of macrophage migration inhibitory factor (MIF)—rs755622 and rs5844572—exhibit prognostic relevance in inflammatory diseases. The aim of this study was to investigate a correlation between these MIF promoter polymorphisms and the severity of hepatitis C virus (HCV)-induced liver fibrosis. Our analysis included two independent patient cohorts with HCV-induced liver fibrosis (504 and 443 patients, respectively). The genotype of the single nucleotide polymorphism (SNP) -173 G/C and the repeat number of the microsatellite polymorphism -794 CATT5–8 were determined in DNA samples and correlated with fibrosis severity. In the first cohort, homozygous carriers of the C allele in the rs755622 had lower fibrosis stages compared to heterozygous carriers or wild types (1.25 vs. 2.0 vs. 2.0; p = 0.03). Additionally, 7 microsatellite repeats were associated with lower fibrosis stages (<F2) (p = 0.04). Comparable tendencies were observed in the second independent cohort, where fibrosis was assessed using transient elastography. However, once cirrhosis had been established, the C/C genotype and higher microsatellite repeats correlated with impaired liver function and a higher prevalence of hepatocellular carcinoma. Our study demonstrates that specific MIF polymorphisms are associated with disease severity and complications of HCV-induced fibrosis in a stage- and context-dependent manner.

No description available.

No description available.

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Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

La glycosylation est un processus enzymatique permettant l'ajout de sucres à des composés (sucres, lipides ou protides), modifiant ainsi leurs propriétés. La glycosylation est impliquée dans la détoxification des xénobiotiques et des variations d'activité des enzymes responsables ont été identifiées comme facteur de risque de cancer en particulier dans les organes exposés aux xénobiotiques. Dans la première partie de notre travail nous étudions l'impact des polymorphismes génétiques de certaines enzymes responsables de la détoxification (UGT1A7, GST et XRCC1) sur le risque de carcinome hépatocellulaire. Nous montrons que la combinaison de certains polymorphismes génétiques peut entraîner une augmentation du risque de CHC. Des modifications d'expression des glycoprotéines de surface ont été observées dans les cellules cancéreuses jouant un rôle dans leurs interactions avec le microenvironnement. Dans la seconde partie, nous étudions l'effet de l'inhibition des interactions des cellules de CHC/cellules endothéliales par le blocage du couple sialyl Lewis x/E-sélectine sur la croissance tumorale. Ce blocage est obtenu, d'une part par transfert du gène de la Fucosyl-transferase I, inhibant l'expression de sLex à la surface des cellules de CHC, et d'autre part, par utilisation de cimétidine ou d'amiloride permettant une inhibition de l'expression de la E-sélectine par les cellules endothéliales. Nous obtenons une inhibition de la croissance tumorale in vivo par blocage de la néoangiogénèse. Ces travaux permettent donc d'identifier des facteurs de risque génétiques de CHC et d'envisager une autre voie de traitement du CHC. / Glycosylation is an enzymatic process that consists of the addition of glycosyl groups to compounds (sugars, lipids or proteins), thus modifying their properties. Glycosylation is involved in the detoxification of xenobiotics and variations in activity of enzymes responsible have been identified as a potential risk factor for cancer in particular in organs in contact with the external environment. In the first part of our work we study the impact of polymorphisms of detoxification enzyme (UGT1A7, GST and XRCC1) on the risk of hepatocellular carcinoma. We show that the combination of genetic polymorphisms of such enzymes may increase the risk of HCC. Modifications in the expression of surface glycoproteins have been observed in cancer cells and play a role in their interactions with the tumoral microenvironment. In the second part, we study the effect of inhibition of interactions of HCC cells / endothelial cells on tumor growth by blocking the interaction between sialyl Lewis x and E-selectin. First, we achieved the inhibition of the expression of sLex on the surface of HCC cells by introducing fucosyl transferase- I gene in HCC cells. In a second part of our work we used cimetidine and amiloride to inhibit the expression of E-selectin by endothelial cells. This approach resulted in inhibition of HCC cells / endothelial cells interaction and thereby tumor growth inhibition in vivo. This effect is mediated by an inhibition of tumor neoangiogenesis. This work therefore identifies genetic risk factors for HCC and allows considering another way of treatment of HCC.

INTRODUCTION: Hepatocellular carcinoma (HCC) is a deadly cancer with increasing incidence in western countries. Diagnosis of HCC is based on imaging exams and most Cancer Centers do not recommend core-biopsies for definitive histopathological confirmation. Moreover, only patients with early disease stage are eligible to curative-intent treatments including surgical resection and liver transplantation. Hence, access to tissue samples in HCC patients with intermediate and advanced disease is limited, which further precluded the evaluation of morphological features and molecular drivers of HCC dissemination, particularly in relation to metastatic spread. Evaluation of autopsy specimens with adequate representation of primary and metastatic disease can overcome such limitations and provide insights on the mechanisms and patterns of distant dissemination in HCC. METHODS: This study included 88 autopsy specimens from patients with HCC, including 20 with distant metastases. Tissue microarrays (TMA) were generated from 194 hepatic and 36 extra-hepatic nodules histologically available from these patients. All nodules were assessed for multiple histological features including degree of differentiation, nuclear, nucleolar and architectural grades, and cellular crowding. Immunohistochemistry (IHC) was performed for markers of hepatocyte differentiation (HepPar1, Arginase and CD10), CTNNB1 mutation status (beta-catenin and Glutamine Synthetase), HCC stem-like features (Keratin 19, CD44 and EpCam), and epithelial-mesenchyme transition (Vimentin and Claudin 1). Phenotypic heterogeneity in the primary disease was assessed in 50 patients with multiple hepatic nodules and heterogeneity in the metastatic disease was evaluated in 12 patients with multiple extra-hepatic nodules. Mutations in the TERT-promoter region was evaluated in six patients with multi-nodular primary and metastatic disease. RESULTS: Metastatic sites included lungs (16/20, 80%), peritoneum (4/20, 20%) lymph nodes (4/20, 20%) and adrenal gland (3/20, 15%). Subclinical micro-metastases, undetected in imaging and macroscopic examination, were identified in 30% of the patients with disseminated disease to the lung. AFP serum concentration >= 100 ng/mL, dominant nodule >= 5.0 cm, multi-nodularity, macrovascular invasion, high histological, nuclear and architectural grades, cellular-crowding, and expression of Keratin 19 and EpCam in the primary disease were associated with the presence of distant metastases in HCC. Histological and IHC analyses showed that all HCC metastatic nodules could be traced back to the primary disease. Phenotypic inter-nodular heterogeneity was detected in 27/50 (54%) patients with multinodular hepatic disease. Heterogeneity was less pronounced in extra-hepatic nodules, being present in only 2/12 (17%) patients with multiple metastatic tumors. These results were further validated by the limited mutation heterogeneity of the TERT-promoter region in metastatic compared to primary nodules. CONCLUSIONS: HCC shows a strong hematogenous tropism and predilection for lung dissemination. Metastatic HCC nodules are enriched in histological features of aggressive behavior and in markers of stem-like properties. The limited phenotypic internodular heterogeneity within the primary compared to metastatic nodules suggests evolutionary constrains in HCC extra-hepatic dissemination / INTRODUÇÃO: Carcinoma hepatocelular (CHC) é um câncer de alta mortalidade e incidência crescente em países ocidentais. O diagnóstico de CHC é realizado através de exames de imagem e a grande maioria dos Centros de Tratamento de Câncer não recomendam biópsias incisionais para confirmação histopatológica do diagnóstico de CHC. Além disso, apenas os pacientes com CHC em estágios precoces são submetidos a tratamentos com intenção curativa como ressecção cirúrgica e transplante hepático. Dessa forma, o acesso a amostras teciduais em pacientes com CHC em estágios intermediários e avançados é bastante limitada, dificultando a avalição de achados morfológicos e eventos moleculares associados a progressão tumoral, e em especial relacionados a disseminação extra-hepática. A avalição de amostras de autópsia com adequada representação da doença primária e metastática pode superar tais limitações e sugerir mecanismos e padrões de disseminação a distância em CHC. MÉTODOS: O presente estudo incluiu 88 autópsias em pacientes com CHC, abrangendo 20 pacientes com metástase à distância. Micro matrizes teciduais (TMA) foram construídas com 194 nódulos hepáticos e 36 nódulos extra-hepáticos desses pacientes. A avaliação dos nódulos incluiu múltiplos critérios histológicos como diferenciação tumoral; graus nuclear, nucleolar e arquitetural, e celularidade. Imuno-histoquímica (IHQ) foi realizada para marcadores de diferenciação hepatocitária (HepPar1, Arginase e CD10), status de mutação de CTNNB1 (Beta-catenina e Glutamina Sintetase), propriedades biológicas de células progenitoras em CHC (Queratina 19, CD44 e EpCam), e marcadores de transição epitélio-mesênquima (Vimentina e Claudina 1). A heterogeneidade fenotípica na doença primaria foi avaliada em 50 pacientes com múltiplos nódulos hepáticos e, na doença metastática, em 12 pacientes com múltiplos nódulos extra-hepáticos. Mutações na região promotora de TERT foram avaliadas em seis pacientes com doença multi-nodular primária e metastática. RESULTADOS: Foram observadas metástases para os pulmões (16/20, 80%), peritônio (4/20, 20%), linfonodos (4/20, 20%) e glândula adrenal (3/20, 15%). Metástases subclínicas, não detectadas em exames de imagem e avaliação macroscópica, foram identificadas em 30% dos pacientes com comprometimento pulmonar. Concentração sérica de alfa-feto-proteína >= 100 ng/mL, nódulo dominante >= 5.0 cm, multi-nodularidade, invasão macrovascular alto grau histológico, nuclear e arquitetural, celularidade e expressão IHQ de Queratina 19 e EpCam na doença primária mostraram associação com a presença de metástases em CHC. Todos os nódulos metastáticos reproduziram os achados histológicos e IHQ da doença primária correspondente. Heterogeneidade fenotípica inter-nodular foi detectada em 27/50 (54%) pacientes com múltiplos nódulos hepáticos. A heterogeneidade extra-hepática foi menos expressiva, presente em apenas 2/12 (17%) pacientes com múltiplos nódulos metastáticos. Também houve limitada heterogeneidade para mutações na região promotora de TERT na doença metastática comparada à doença primária. CONCLUSÕES: CHC tem forte tropismo hematogênico e predileção por metástases pulmonares. O CHC metastático possui alta prevalência de altos graus histológicos e de marcadores de células progenitoras. A restrita heterogeneidade fenotípica da doença metastática comparada à doença primária sugere restrições evolutivas e seleção de clones tumorais na disseminação extra-hepática de CHC

Mutações no gene HFE têm sido apontadas como um dos principais fatores para o desenvolvimento de sobrecarga de ferro, especialmente os SNPs (single nucleotide polymorphism) clássicos C282Y e H63D. A sobrecarga de ferro pode ser primária, atribuída diretamente a mutações do gene HFE (hemocromatose hereditária - HH) ou adquirida em decorrência de fatores genéticos e de comorbidades, particularmente, infecção pelo vírus da hepatite C (HCV) e carcinoma hepatocelular (CHC). Desequilíbrio de ligação entre os SNPs principais do gene HFE com alelos dos genes HLA-A e HLA-B podem contribuir com alterações da função das células do sistema imunológico. Neste trabalho, sequenciamos a região codificadora do gene HFE (éxon 2, 3, 4 e 5) de pacientes que apresentam ou não sobrecarga de ferro primária ou adquirida. Assim, estudamos 130 pacientes com hepatite C, 60 pacientes com CHC, 14 pacientes com HH e 100 indivíduos saudáveis. Foram encontrados sete SNPs no gene HFE no sentido 5\' para 3\': i) H63D C>G no éxon 2 (rs1799945); ii) IVS2(+4)T>C no íntron 2 (rs2071303); iii) íntron 3 C>G (rs807209); iv) C282Y G>A no éxon 4 (rs1800562); v) íntron 4 G>A (rs2794717); vi) IVS4(-44) T>C (rs1800708); vii) no íntron 5 a deleção G>del, ainda não foi descrita na literatura. Foram realizadas as reconstruções de haplótipos da região codificadora e os haplótipos estendidos englobando o gene HFE e dez outros loci (HLA-A, HLA-B, HLA-C, HLA-DRB1, HLA-DQB1, TNFa, TNFb, TNFc, TNFd e HLA-G-14pb). Também, normatizamos a nomenclatura do gene de acordo com as regras do The International ImMunoGeneTics Information System - IMGT (http://www.imgt.org/). Diversas ferramentas foram utilizadas para avaliar a associação entre os sítios polimórficos do gene HFE com a sobrecarga de ferro, incluindo testes de associações avaliando alelos, genótipos, desequilíbrio de ligação, haplótipos e diplótipos, testes de diversidades e neutralidade. Finalmente, comparamos os SNPs do gene HFE encontrados na população saudável do presente trabalho com as diversas populações mundiais, disponíveis no sítio 1000genomes (http://www.1000genomes.org/). Os resultados demonstraram que a nossa a população estava mais próxima das populações europeias e americanas, sendo parcialmente próxima das populações africanas e distante das populações asiáticas. O alelo C282Y G, contido no haplótipo da região codificadora HFE*01:03, conferiu susceptibilidade a HH na população brasileira testada, concordando com os achados observados em outras populações mundiais. O diplótipo HFE*01:02:01:01/HFE*01:01:01:05 conferiu susceptibilidade para o desenvolvimento de sobrecarga de ferro em pacientes com CHC causado pelo HCV. Detectamos forte desequilíbrio entre os alelos H63D G e IVS2(+4) C no éxon 2 do gene HFE, e concomitantemente, desequilíbrio desses alelos com alelo HLA-B*44, aparentemente, sem associação com sobrecarga de ferro, mas com aparente origem histórica. Finalmente, o teste de diversidade encontrou diferenças apenas na amostra de HH e o teste de neutralidade não encontrou pressões seletivas na população controle do presente trabalho. Concluindo, este é o primeiro trabalho, avaliando grande segmento da região codificadora do gene HFE em diversas amostras de pacientes apresentando ou não sobrecarga de ferro e em indivíduos controle. / Mutations at the HFE gene have been identified as a major factor for the development of iron overload, especially the classical single nucleotide polymorphism (SNP) C282Y and H63D. Primary iron overload can be directly attributed to mutations in the HFE gene (hereditary hemochromatosis - HH), whereas secondary overload may be acquired due to genetic factors and comorbidities, particularly infection with hepatitis C virus (HCV) and hepatocellular carcinoma (HCC). Linkage disequilibrium between major SNPs at the HFE gene with HLA-A and HLA-B alleles may contribute to alterations in the function of immune cells. We sequenced the coding region of the HFE gene (exon 2, 3, 4 and 5) of patients exhibiting primary or secondary iron overload. Thus, we studied 130 patients with hepatitis C, 60 patients with HCC, 14 patients with HH and 100 healthy individuals. We observed seven SNPs in the HFE gene in 5 \'to 3\' sequence: i) H63D C>G at exon 2 (rs1799945); ii) IVS2(+4)T>C at intron 2 (rs2071303); iii) intron 3 C>G (rs807209); iv) C282Y G>A at exon 4 (rs1800562); v) intron 4 G>A (rs2794717); vi) IVS4(-44) T>C (rs1800708); vii) at intron 5 we detected a yet undescribed G>deletion. We performed haplotype reconstruction of the coding region and extended haplotypes comprising the HFE gene and ten other loci (HLA-A, HLA-B, HLA-C, HLA-DRB1, HLA-DQB1, TNFa, TNFb, TNFc, TNFd and HLA-G14bp). In addition, we normatized the nomenclature of the HFE gene, according to the rules of the International ImMunoGeneTics Information System - IMGT (http://www.imgt.org/). Several tools were used to evaluate the association between HFE polymorphic sites with iron overload, including tests assessing associations of alleles, genotypes, linkage disequilibrium, haplotype and diplotypes, diversity and neutrality tests. Finally, we compare the SNPs at the HFE gene observed in the healthy population with those observed in diverse worldwide populations available at the 1000genomes site (http://www.1000genomes.org/) the results showed that our population was closer to American and European populations, partially close the populations of African and distant of Asian populations. The C282Y allele G, contained in the coding region HFE * 01:03 haplotype, conferred susceptibility to HH in the Brazilian population tested, agreeing with the findings observed in other worldwide populations. The HFE*01:02:01:01/HFE* 01:01:01:05 dyplotype conferred susceptibility to the development of iron overload in patients with HCC caused by HCV. A strong linkage disequilibrium was detected between the H63D G and IVS2 (+4) C alleles in exon 2 of the HFE gene, and concomitantly, a linkage between these alleles with HLA-B*44, apparently not associated with iron overload, but with apparent historical origin. Finally, the test of diversity revealed differences only in the HH sample and the neutrality test detected no selective pressures on the control population of this study. In conclusion, this is the first study evaluating a large segment of the coding region of the HFE gene in several samples of patients exhibiting or not iron overload and in control subjects.

INTRODUÇÃO: Enquanto a análise de sobrevida tradicional estima inadequadamente o prognóstico futuro dada alguma sobrevida inicial, a sobrevida condicional ajusta a sobrevida futura pela já observada, permitindo a compreensão da distribuição temporal do impacto dos preditores. OBJETIVOS: Estimar e analisar as sobrevidas global e livre de doença até o décimo ano pós-operatório; identificar preditores independentes destes desfechos; estimar e analisar as sobrevidas condicionais global e livre de doença de cinco anos dada a sobrevida até o quinto ano pós-operatório; analisar o comportamento dos preditores dos desfechos ao longo do tempo. MÉTODOS: Estudo retrospectivo envolvendo 13 centros brasileiros. Dados clínicos, radiológicos e anatomopatológicos foram considerados. Utilizou-se o método de Kaplan-Meier com o teste log-rank para comparar fatores e a regressão de Cox obteve a razão de riscos. A sobrevida condicional foi calculada a partir das tábuas de sobrevida e a diferença padronizada reavaliou as variáveis consideradas significativas. RESULTADOS: 1157 pacientes foram incluídos. A sobrevida global de 1, 3, 5, 7 e 10 anos foi 78,6%, 72,3%, 66,0%, 61,3% e 59,4%, respectivamente. Foram preditoras de sobrevida global: idade [HR 1,04 (IC 95% 1,02-1,06), p 0.000], sexo feminino [HR 1,35 (IC 95% 1,02-1,79), p 0.038], recidiva pós-operatória do CHC [HR 1,35 (IC 95% 1,08-1,79), p 0.003], diâmetro do maior nódulo viável no explante [HR 1,01 (IC95% 1,01-1,02), p 0.006], invasão vascular não discriminada [HR 3,18 (IC95% 1,48-6,85), p 0.004], invasão micro [HR 1,65 (IC 95% 1,27-2,15), p 0.001] e macrovascular [HR 2,25 (IC 95% 1,30-3,89), p 0.000]. A sobrevida condicional global de 5 anos ao final do 1°, 3° e 5° anos foi 79,5%, 82,2% e 90,0%, respectivamente. As variáveis preditoras na análise univariada tiveram comportamento errático ao longo do tempo. A sobrevida atuarial livre de doença em 1, 3, 5, 7 e 10 anos foi 94,2%, 90,1%, 89,8%, 87,5% e 87,5%, respectivamente. Foram preditoras de sobrevida livre de doença: nível sérico de alfa-fetoproteína no diagnóstico [HR 1,0 (IC 95% 1,01-1,02), p 0.000], CHC dentro do critério de Milão no diagnóstico [HR 0,42 (IC 95% 0,22-0,80), p 0.008], explante dentro do critério de Milão [HR 0,34 (IC 95% 0,17-0,68), p 0.002], explante com neoplasia pouco diferenciada ou hepatocolangiocarcinoma [HR 3,04 (IC 95% 1,75-5,30), p 0.000], invasão vascular não discriminada [HR 15,72 (IC 95% 3,44-71,83), p 0.000], invasão micro [HR 3,40 (IC 95% 1,83-6,28), p 0.000] e macrovascular [HR 11,96 (IC 95% 5,20-27,47), p 0.000]. A sobrevida condicional livre de doença de 5 anos ao final do 1°, 3° e 5° anos foi 94,1%, 97,1% e 97,4%, respectivamente. Variáveis preditoras na análise univariada em geral tem maior impacto no primeiro ou segundo ano. CONCLUSÕES: Os resultados do transplante no Brasil foram comparáveis àqueles observados nos EUA e Europa. Considerando-se as perdas precoces, as curvas de sobrevida pelo método Kaplan-Meier foram pessimistas e a análise de sobrevida condicional fornece outra perspectiva para estes dados. O comportamento das variáveis determinantes de prognóstico não é uniforme ao longo do tempo / INTRODUCTION: Traditional survival analysis provides inadequate estimates of the future prognosis for patients with accrued survival. Conversely, conditional survival adjusts future survival by the already accrued survival. It provides insights into the temporal distribution of the effect of predictors. OBJECTIVES: To estimate and to analyse overall and disease free survival until the 10th post-operative year; to identify independent predictors of these outcomes; to estimate and to analyse 5-year overall and disease free conditional survival until the 5th post-operative year; to analyse the behaviour of the predictors of outcomes during follow-up. METHODS: Retrospective cohort from 13 Brazilian transplantation centers. Clinical, radiological, and anatomopathological data were considered. The Kaplan-Meier method with the longrank test for the comparison of factors was applied and the Cox proportional hazards model provided the hazard ratios. Conditional survival was calculated through life tables, while differences between significative variables were reassessed by the standardized difference. RESULTS: 1157 patients were included. Overall survival in 1, 3, 5, 7 and 10 years was 78.6%, 72.3%, 66.0%, 61.3%, and 59.4%, respectively. 350 (30.3%) deaths were observed, 240 (68.6%) in the 1st year. Overall survival was independently predicted by age [HR 1.04 (95% CI 1.02-1.06), p 0.000], female sex [HR 1.35 (95% CI 1.02-1.79), p 0.038], post-operative HCC recurrence [HR 1.35 (95% CI 1.08-1.79), p 0.003], diameter of the largest viable nodule on the explant [HR 1.01 (95% CI 1.01-1.02), p 0.006], non-discriminated vascular invasion [HR 3.18 (95% CI 1.48-6.85), p 0.004], micro [HR 1.65 (95% CI 1.27-2.15), p 0.001] and macrovascular invasion [HR 2.25 (95% CI 1.30-3.89), p 0.000]. 5-year overall conditional survival at the end of the 1st, 3rd and 5th post-operative years was 79.5%, 82.2%, and 90.0%, respectively. Predictors of overall survival identified on univariate analysis presented an erratic behaviour over time. Disease free survival in 1, 3, 5, 7 and 10 years was 94.2%, 90.1%, 89.8%, 87.5%, and 87.5%, respectively. 97 (8.4%) reccurrences occurred. Disease free survival was independently predicted by serum alpha-fetoprotein upon diagnosis [HR 1.0 (95% CI 1.01-1.02), p 0.000], HCC within the Milan criteria upon diagnosis [HR 0.42 (95% CI 0.22-0.80), p 0.008], explant within the Milan criteria [HR 0.34 (95% CI 0.17-0.68), p 0.002], undifferentiated tumor or hepatocholangiocarcinoma on the explant [HR 3.04 (95% CI 1.75-5.30), p 0.000], non-discriminated vascular invasion [HR 15.72 (95% CI 3.44-71.83), p 0.000], micro [HR 3.40 (95% CI 1.83-6.28), p 0.000], and macrovascular invasion [HR 11.96 (95% CI 5.20-27.47), p 0.000]. 5-year disease free conditional survival at the end of the 1st, 3rd and 5th post-operative years was 94.1%, 97.1%, and 97.4%, respectively. Predictors of recurrence on the univariate analysis usually presented with greater impact during the 1st or 2nd post-operative year. CONCLUSIONS: Outcomes of liver transplantation in Brazil were comparable to those from the US and Europe. Survival estimates through the Kaplan-Meier method were pessimistic due to greater early losses. Conditional survival offers a different perspective for the same data. The behaviour of predictive values varies over time

O objetivo principal deste estudo foi avaliar fatores virais associados com a evolução para o carcinoma hepatocelular (CHC) em pacientes com hepatite B crônica. Para tanto caracterizamos os subgenótipos do HBV, investigamos a ocorrência de mutações nos genes pré-core/core do HBV associadas à presença de CHC avaliamos por análise filogenética a associação de linhagens virais com a ocorrência de CHC e por fim a associação de outros fatores de risco com o desenvolvimento de CHC. Foram incluídos 119 amostras de soro de pacientes com infecção crônica pelo HBV, destas amostras 60 pertencem ao grupo 1 (CHC), que são pacientes com diagnóstico confirmado de carcinoma hepatocelular e 59 amostras pertencem ao grupo 2 (sem CHC) que são pacientes com hepatite crônica sem detecção prévia de nódulos hepáticos. Foram obtidas informações acerca da idade, sexo e naturalidade. Além disso, os pacientes responderam a um questionário sobre fatores de riscos associados ao desenvolvimento de CHC. Foram realizados exames bioquímicos, sorológicos, determinação da carga viral, e amplificação por nested PCR e sequenciamento das regiões S/polimerase e pré-core/core do genoma viral para posterior caracterização dos genótipos/subgenótipos do HBV e pesquisa de mutações associadas com evolução da doença hepática. Em relação à idade e sexo não houve grande variação entre os grupos. Quanto à naturalidade a maioria era procedente da região sudeste, seguido pela região nordeste; e por fim seis pacientes eram procedentes de outros países. Com base no sobrenome dos pacientes avaliou-se também a frequência de etnia oriental na casuística estudada, que foi similar nos 2 grupos. O perfil sorológico HBeAg negativo foi o mais frequente nos dois grupos de pacientes, assim como níveis de carga viral abaixo de 2.000 UI/mL. Em relação aos exames bioquímicos foram observadas diferenças estatisticamente significantes nos níveis séricos de AFP (p= 0,0013), FA (p= 0,0003) e GGT (p= 0,005). Dentre os fatores de risco analisados neste estudo, o consumo de amendoim foi o único que apresentou significância estatística (p= 0,003). A região S/pol foi amplificada e sequenciada com sucesso em 58 amostras (28 do grupo 1 e 30 do grupo 2). Entre as 58 amostras analisadas 4 genótipos e 8 subgenótipos do HBV foram identificados, sendo o subgenótipo A1 o mais frequente nos dois grupos. Não se observou diferença estatisticamente significante na distribuição dos subgenótipos entre os dois grupos de pacientes. Na topologia da árvore filogenética construída com sequências do HBV isoladas dos pacientes incluídos neste estudo e sequências disponíveis no GenBank não se observou padrões de agrupamento associados com o perfil clinico do paciente (com e sem CHC). Foram obtidas sequências de boa qualidade da região précore/ core em 44 amostras, sendo 20 amostras do grupo 1 e 24 do grupo 2. Diversas das mutações investigadas foram identificadas na região précore/ core, as quais foram avaliadas estatisticamente para verificar a existência de diferença na frequência das mesmas entre os grupos de pacientes estudados. Entre as mutações identificadas se destacaram com significância estatística as seguintes mutações: T1768A (p= 0,006), a combinação das mutações C1766T + T1768A (p= 0,043) e G1888H (p= 0,05). Na análise de regressão logística simples foi possível identificar que a chance de um paciente do grupo 2 desenvolver CHC aumenta 14,7 vezes na presença de infecção por cepas do HBV com a mutação T1768A, enquanto que a infecção com cepas do HBV que albergam a mutação G1888H reduz tal chance 2,5 vezes / The aim of this study was to evaluate viral factors associated with the progression to hepatocellular carcinoma (HCC) in patients with chronic hepatitis B. For this goal, we characterized HBV subgenotypes, investigated the occurrence of mutations in pre-core/core genes associated with progression to HCC, characterized HBV strains through phylogenetic analyzes and evaluated risk factors associated with HCC. Were included 119 serum samples from patients with chronic HBV infection that were classified in 2 groups: 60 patients with confirmed HCC diagnosis (group 1) and 59 patients with advanced hepatitis B liver disease without the detection of nodular liver lesions and without HCC (group 2). Data about the age, sex and geographic precedence were obtained from medical records. The patients also answered a questionnaire on risk factors for developing HCC. Biochemical, serological and viral load testing were performed in all samples. Moreover, S/polymerase and precore /core regions of HBV DNA were amplified by nested PCR and sequenced by Sanger method. Sequences were analyzed to identify HBV genotypes and subgenotypes and to detect mutations in the precore/core gene. Patient\'s age and sex did not differ between the two groups. Most of the patients came from the Southeast region, followed by the Northeast region; and six patients were from other countries. Based on the patient\'s surname, they were evaluated concerning Eastern ethnicity, which was similar in the 2 groups. Most of the patients included in this study were HBeAg negative and showed viral load bellow 2,000 IU/mL. Concerning the biochemistry assays, statistically significant differences in serum levels of AFP (p = 0.0013), AP (p = 0.0003) and GGT (p = 0.005) were found. Among the risk factors analyzed in this study, peanut consumption was the only one statistically significant (p = 0.003). The S/pol region was successfully amplified and sequenced in 58 samples (28 from Group 1 and 30 from Group 2). Among the 58 samples analyzed, 4 genotypes and 8 subgenotypes were identified, subgenotype A1 was the most frequent in both groups and there was no statistically significant difference in the distribution of them between the two groups. In the phylogenetic tree topology built with HBV sequences isolated from patients included in this study and sequences available in GenBank, it was not observed any clustering associated with the clinical profile of the patients (with or without HCC). Sequences of good quality from pre-core/core region were obtained from 44 samples, 20 from group 1 and 24 from group 2. These sequences were analyzed and several mutations were found among which stood out with statistical significance: T1768A (p = 0.006) C1766T + T1768A (p = 0.043) and G1888H (p = 0.05). In addition to the comparative analysis, the changes were subjected to a simple logistic regression analysis which found that the chance of a patient in group 2 developed HCC increases 14.7 times in the presence of HBV infection strains with the T1768A mutation, while infection with HBV strains harboring the mutation G1888H reduces this chance by 2.5 times