Primitive liver cancers: epidemiology and geographical study in France

The objectives of this study are, first, to describe the incidence of primary liver cancer (PLC) and, second, to highlight its epidemiological characteristics from a geographical point of view.

The nine French administrative areas, which are covered by population-based cancer registries, diagnosed a total of 1100 new cases of PLC (of which 898 occurred in males), between 1997 and 1998; 91.5% of these were identified as hepatocellular carcinoma, and 6.2% corresponded to intrahepatic cholangiocarcinoma. The incidence rates of these new cases were studied as a function of their clinico-pathological features and geographical location.

The age-adjusted incidence was 9.5 per 100,000 persons amongst males, and 3.1 per 100,000 persons amongst females. The origin of cirrhosis was found to be alcohol consumption (69%), followed by viral contamination, and lastly 4.9% for both. A north-south gradient was found for the age-standardized incidence rates in men (10.1 per 100,000 in the north vs. 6.5 per 100,000 in the south; P=0.029). Amongst men in the north, the most frequent etiological type was cirrhosis (79.8 vs. 72.5%; P=0.0018). The alcoholic origin of cirrhosis was more frequent in the north than in the south (66 vs. 27.5%; P<10). Viral cirrhosis was more frequent in the south than in the north (42.9 vs. 13.6%; P<10).

In France, excessive alcohol consumption remains the main risk factor for PLC, although the viral etiology of this disease is growing. An opposition was found between the two groups. North-men-alcoholic cirrhosis and south-women-viral cirrhosis.