HEPATOCELLULAR-CARCINOMA IN ALCOHOLIC CIRRHOSIS - IS SEX-HORMONE IMBALANCE A PATHOGENETIC FACTOR

Objective: A sex hormone imbalance has been reported in patients with hepatocellular carcinoma (HCC). We investigated the serum levels of ei ght sex hormones in patients with alcohol-related and non-alcohol-rela ted cirrhosis and HCC. Methods: Luteinizing hormone, follicle-stimulat ing hormone, estradiol, progesterone, testosterone, androstenedione, d ehydroepiandrosterone and sex hormone binding globulin were assayed in 81 patients with cirrhosis (59 men, 22 women) and 97 with HCC and cir rhosis (82 men, 15 women). Hepatitis B or hepatitis C virus infection was present in 58% of patients with cirrhosis and 69% of patients with HCC. Alcohol abuse was the aetiopathogenetic factor in the remaining patients. Results: In men, mean testosterone levels were at the lower limit of the normal range for both patients with HCC and for controls with cirrhosis. Mean estradiol levels were increased both in patients with HCC and in those with cirrhosis, but patients with alcohol-relate d HCC had higher estradiol levels (P=0.0002). An index of sex hormone imbalance, the estradiol to testosterone ratio (ETR), was calculated. The ETR was significantly higher in patients with alcohol-related HCC (P=0.0002). Multiple regression analysis showed that the ETR correlate d best with patients' diagnosis (P<0.05). In women, the ETR was signif icantly lower in patients with HCC than in controls with cirrhosis. Co nclusions: Men with alcohol-related HCC are characterized by an oestro gen and androgen imbalance and have a higher ETR than patients with ot her types of liver damage. Since sex hormones modulate hepatocellular proliferation, our data suggest that a sex hormone imbalance plays a r ole in hepatocarcinogenesis in patients with alcohol-related cirrhosis .