Aflatoxins as a risk factor for hepatocellular carcinoma in Egypt, Mansoura Gastroenterology Center study

Aflatoxin B1 (AFB1) is an important food-borne mycotoxin. The co-contamination of foodstuffs with this mycotoxin is well known and has been possibly implicated in the development of hepatocellular carcinoma in high risk regions around the world. This study investigates the serum aflatoxin B1 in patients with hepatocellular carcinoma and compares it to a control group.

From January 2005 to January 2006, 80 cases with hepatocellular carcinoma diagnosed in the Gastroenterology center, Mansoura University, Egypt and 20 healthy subjects used as a control group were enrolled in the study. All patients were evaluated for age, sex, residence, occupation, history of other medical diseases, anti-bilharzial treatment, blood transfusion, viral markers, liver functions and serum level of aflatoxin B1.

The mean age of our patients was 52.88 +/- 7.27 years versus 53.17 +/- 6.78 years for the controls, p>0.05. The serum level of AFP1 was highly significant in HCC patients compared with control (32.47 +/- 92.46 versus 7.33 +/- 5.5 P<0.0001) and it was statistically high between 51:60-years-old (P<0.05). Males represented 82.5% of the patients versus 17.5% for females. AFB1 was higher in males compared with females (P<0.05), higher in rural residents compared with urban residents (P<0.05), higher in Kafer Elchek government are versus others (P<0.01) and higher in farmers compared with those with other occupations (P<0.05). The serum level of AFB1 was high among patients with a history of anti-bilharzial treatment with tarar emetic versus oral treatment by Brazequantil (P<0.05). Hepatitis C antibody was positive in 70% of the patients. The serum level of AFB1 was statistically high in HCV-positive patients compared with HCV-negative ones (P<0.05) but showed no statistical significance in HBs-positive patients compared with HBs-negative ones (P>0.05). The serum level of AFB1 was statistically high in Child class B patients compared with class A (P<0.05), high in patients with tumor size > 5 cm compared with tumor size < 5 cm (P<0.05), high in right lobe tumor patients compared with left lobe tumor (P>0.05), high in multifocal hepatoma patients compared with single lesion patients (P<0.05). The serum level of AFB1 showed a statistically significant positive correlation with serum SGPT and alpha-fetoprotein.

Aflatoxin B1 may play an important role in the occurrence of HCC in the north Nile delta area and especially in males, farmers, and rural residents, HCV infection, cirrhotic liver and multifocal hepatoma patients. Aflatoxin B1 in high concentration is associated with high incidence of chronic HCV, and affects hepatic parenchyma and multifocal lesions.