A case-control study was carried out to investigate the impact of factors including virus infection, aflatoxin B1, microcystins, smoking/drinking and dietary habits as well as genetic polymorphisms of aldehyde dehydrogenase 2 (ALDH2) and cytochrome P4502E1 (CYP2E1), on susceptibility to hepatocellular carcinoma (HCC) in Haimen, China. A total of 248 patients with HCC and 248 sex-, age-and residence-matched population-based controls were recruited into the study.

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A 60‐year‐old man with a chronic hepatitis C virus (HCV) infection and histological features of chronic active hepatitis was treated with interferon‐a (IFN). He successfully responded to IFN with normalization of serum ALT and disappearance of serum HCV‐RNA. His liver biochemistry profile remained normal and serum HCV‐RNA was not detected throughout the entire follow‐up period. One year later, a small hepatocellular carcinoma (HCC) was detected by routine ultrasonographic screening. Laparotomy revealed a small tumour with no metastasis and the nontumorous liver demonstrated macronodular cirrhosis. Although no space‐occupying lesions were detected by frequent radiological examinations prior to IFN therapy, the small size of the tumour suggested de novo development of HCC. Patients with chronic HCV infection, including those who have complete responses to IFN and lack clinical and histological evidence of cirrhosis, should be followed up for the potential development of HCC.