EPIDEMIOLOGY OF HEPATOCELLULAR-CARCINOMA - EVALUATION OF VIRAL AND OTHER RISK-FACTORS IN A LOW-ENDEMIC AREA FOR HEPATITIS-B AND HEPATITIS-C

To assess whether hepatocellular carcinoma (HCC) in patients with cirr hosis of the liver is associated with particular risk factors, a retro spective, case-control study was performed. Eighty-six patients with H CC (90% had underlying cirrhosis of the liver) were compared with 86 c ontrols who had cirrhosis but not hepatocellular carcinoma. Hepatitis B surface antigen (HBsAg), antibodies to hepatitis B core antigen (ant i-HBc), and to hepatitis C virus (anti-HCV) were evaluated; and alcoho l and nicotin abuse were assessed by history. The prevalence of HBsAg and anti-HBc was similar in both, case and control patients. Antibodie s to hepatitis C virus were detected more frequently among patients wi th HCC and cirrhosis (37%) compared to cirrhosis alone (22%). Alcohol abuse was found more frequently in patients with cirrhosis alone. Smok ing habits were comparable between the two groups. None of the tested variables were related to an increased risk for HCC. Using an ordinary logistic regression approach, none of the variables could be identifi ed as an independent risk factor for HCC. However, the combination of hepatitis B virus infection and hepatitis C virus infection was more p revalent in the patients with hepatocellular carcinoma and cirrhosis ( 48%) when compared to patients with cirrhosis alone (13%) (odds ratio 6.364; Cl 1.1 49-35.229). In conclusion, we failed to identify indepen dent risk factors for the development of HCC in Germany. However, the combination of hepatitis B and C virus infection increases the risk fo r liver cancer. Molecular analyses have to be performed to elucidate v iral hepatocarcinogenesis.