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Hepatocellular carcinoma. A worldwide problem and the major risk factors
R G Simonetti1, C Cammà, F Fiorello
1Divisione di Medicina Generale, Ospedale V. Cervello, Palermo, Italy.
Insights
Hepatitis B virus (HBV) infection and cirrhosis are key drivers of hepatocellular carcinoma (HCC). Geographic variations in HCC incidence are linked to HBV prevalence, with vaccination crucial for global prevention.
Area of Science:
- Hepatology
- Oncology
- Epidemiology
Background:
- Hepatocellular carcinoma (HCC) exhibits significant geographic variability in incidence.
- Major risk factors for HCC include male sex, advanced age, cirrhosis, and Hepatitis B surface antigen (HBsAg) positivity.
Purpose of the Study:
- To investigate the reasons behind the geographic variability of HCC incidence.
- To assess the role of risk factors, particularly HBV, in different HCC incidence areas.
Main Methods:
- Comparative analysis of HCC risk factors across distinct geographic incidence areas.
- Assessment of HBsAg prevalence in HCC patients and the general population.
- Review of existing data on cirrhosis and chronic Hepatitis C virus (HCV) infection as risk factors.
Main Results:
- HBsAg prevalence is highest in Africa and Asia, correlating with high HCC incidence and suggesting perinatal HBV infection as a major cause.
- Cirrhosis is the primary risk factor in regions with lower HBV prevalence.
- HBsAg carriage exacerbates HCC risk in individuals with cirrhosis, explaining higher incidence in certain populations.
Conclusions:
- Hepatitis B virus hyperendemicity and perinatal transmission significantly contribute to high HCC rates in Africa and Asia.
- While HBV vaccination is essential for global HCC reduction, preventing other causes of cirrhosis is crucial in regions with low HBsAg carriage.
- Chronic HCV infection is also implicated as a risk factor for cirrhosis and HCC.
Abstract:
Male sex, age, cirrhosis, and HBsAg are the major risk factors for hepatocellular carcinoma (HCC). The geographic distribution of HCC is highly uneven, such that three distinct incidence areas are recognized. To clarify the reason(s) for this geographic variability of HCC, the risk factors in each incidence area were assessed. In parallel with the geographic distribution of HCC, HBsAg prevalence was highest in both HCC patients and in general population in Africa and Asia, where mothers of HCC patients are frequently HBsAg-positive, suggesting that hepatitis B virus hyperendemicity and perinatal infection account for the high HCC incidence in these areas. Cirrhosis, which is found on autopsy in 80% of the cases of HCC patients worldwide, is the most prevalent risk factor for HCC in areas where hepatitis B virus infection is less common. However, HBsAg carriage adds to the HCC risk carried by cirrhosis and explains the higher incidence of HCC in cirrhotics from Africa and Asia as well as elsewhere. Available data suggest that chronic HCV infection is a risk factor for cirrhosis and HCC. HBV vaccination should decrease HCC incidence rates worldwide; however, HCC prevention in regions where HBsAg carriage is infrequent may also require prevention of the other causes of cirrhosis in order for HCC rates to decline.