Risk Factors for Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC), the third leading cause of cancer deaths worldwide, with incidence rising is expected to increase by another 81% by the year 2020, primarily due to the hepatitis C epidemic. The strongest risk factors for the development of HCC is a hepatitis B (HBV) and hepatitis C (HCV) virus infection, as well as cirrhosis of any cause. Other risk factors that have been reported include exposure to aflatoxin, alcohol, tobacco, obesity and diabetes. To detect potentially curable cases of hepatocellular carcinoma, outpatients with chronic liver disease who have been seen at the Dr. Ion Cantacuzino Hospital, since 10 years and examined periodically with real-time ultrasonography and measurement of serum alpha-fetoprotein.We analyzed the data on these patients for risk factors for hepatocellular carcinoma.

The risk of liver cancer in men was 1.33 times higher than in women; patients in their 60s had significantly higher rate ratios (6.46) than patients in their 40s; patients with liver cirrhosis diagnosed at enrollment had significantly higher rate ratios for liver cancer (1.93) than patients with chronic hepatitis. The high serum alpha-fetoprotein level at enrollment was also confirmed as a significant marker for a high risk, regardless of the stage of disease (chronic hepatitis or liver cirrhosis). The serum markers for hepatitis virus -- HBsAg, and anti-HCV - were significantly associated with the risk of liver cancer: the adjusted rate ratios for HBsAg, anti-HBc, and anti-HCV were estimated to be 6.92, 4.54, and 4.09, respectively. Hepatitis B surface antigen (rate ratio 6,92; 95% CI: 2.92 to 16.39) and hepatitis C antibody (rate ratio 4.09; 95% CI: 1.30 to 12.85) showed the most risk for carcinoma.

Further studies are required to clarify the roles of other risk factors, including drinking and smoking habits.