Hepatocellular carcinoma in Belgium: clinical and virological characteristics of 154 consecutive cirrhotic and non-cirrhotic patients

Objective This study analyses the characteristics of patients with hepatoce llular carcinoma (HCC) in a low endemic area with special emphasis on the d ifferences between cirrhotic and non-cirrhotic patients. Design and setting The files of 154 consecutive patients with HCC observed in a single tertiary care hospital have been investigated to determine epid emiological parameters and diagnostic procedures. Results Compared to non-cirrhotic cases, cirrhotic patients with HCC are ol der and have a more pronounced male predominance. Their disease is more adv anced, they usually present with multi-focal tumours, rarely located in the left liver lobe, Antibodies to hepatitis C (anti-HCV) are present in 55%, 52% ever had contact with hepatitis B (HBV) and 31% were hepatitis B surfac e antigen (HBsAg)-positive. Six non-cirrhotic cases were anti-HCV-positive. a-fetoprotein (AFP) elevation >50 and >400 mu g/l was more frequently obse rved in cirrhotic patients with HCC (P = 0.016). A striking association was found between enhanced AFP levels and the presence of anti-HCV (P = 0.0006 ), while no such relation existed for AFP and HBV markers. The sensitivity of a 'routine' ultrasound examination is disappointing for the early detect ion of HCC in cirrhotic patients. Conclusions In our hospital, in a low endemic area for HCC, we have a surpr isingly high proportion of noncirrhotic patients with HCC (40%). In cirrhos is, usually the consequence of alcohol abuse or hepatitis B or C, small tum ours can be missed by ultrasonography if not specifically looked for. AFP l evels are particularly elevated in hepatitis C-induced HCC. (C) 2000 Lippin cott Williams & Wilkins.