[Current etiological problems, in France, posed by primary liver cancer after cirrhosis. Personal observations of 130...

The etiological problems concerning, in France, hepatocellular carcinoma (HCC) developed on liver cirrhosis, are studied in this work through 130 personal cases followed up during the last decade. These 130 cases of HCC are divided in five groups according to apparent etiology: alcoholic (63 p. cent), B virus, (15.3 p. cent), cryptogenetic (11.5 p. cent), hemochromatosic (7.6 p. cent), autoimmune (2.3 p. cent). A review of these cases according to recent publications shows an evidence underestimated for years: we mean the important role played in France by HBV (and probably HCV) not only in chronic cirrhogen hepatitis, but even more in cancerisation of cirrhosis in general whatever is the apparent etiology. This role, unsuspected when biological investigations are limited to serological markers of HBV, is demonstrated by implementing more sophistical technics (molecular hybridation and genic amplification). But it is very unlikely that this role is exclusive and one must recognize that viral "focalisation" of recent publications has a tendancy to hide other causes of HCC and primarily the toxicological etiology in a wide sense. This etiology is in fact indubitable, already in tropical areas, where the role of mycotoxins and particularly of aflatoxin B1 is very well demonstrated, even in areas of very high incidence of HBV. In low incidence areas, such as France, the specific carcinogenic role of alcohol cannot be excluded, neither the role of numerous experimental hepato-carcinogens, very much studied 15 years ago and may be incorrectly forgotten in our days.(ABSTRACT TRUNCATED AT 250 WORDS)