Etiology of hepatocellular carcinoma in Italian patients with and without cirrhosis

We performed a case-control study to assess the role of hepatitis B virus ( HBV), hepatitis C virus (HCV), GB virus C/hepatitis G virus (HGV), TT virus , alcohol intake, and tobacco smoking as risk factors for hepatocellular ca rcinoma (HCC) in the presence or absence of cirrhosis, We prospectively rec ruited 174 patients with a first diagnosis of HCC admitted to the main hosp itals in Brescia, North Italy. On the basis of histological, clinical, and radiological criteria, the presence of cirrhosis was established in 142 cas es, excluded in 21 cases, and remained undefined in 11 cases. Among the HCC cases without cirrhosis, a histological picture of normal liver was found in a single patient, chronic viral hepatitis was found in 11 patients, alco holic hepatitis was found in 5 patients, nonspecific reactive hepatitis was found in 3 patients, and hemochromatosis was found in 1 patient. As contro ls, we also included 610 subjects unaffected by hepatic diseases and admitt ed to the same hospitals as cases. The odds ratios for having HCC according to positivity for HCV RNA, HBsAg and/or HBV DNA, and alcohol intake > 80 g /day (95% confidence interval) were as follows, in the presence and absence of cirrhosis, respectively: (a) 33.5 (17.7-63.4) and 19.7 (6-64.8) for HCV RNA; (b) 17.6 (9.0-34.4) and 20.3 (5.7-72.6) for HBsAg; and (c) 5.5 (3.1-9 .7) and 4.6 (1.5-13.8) for alcohol intake. No association was found with HG V or TT virus infections or tobacco. This study has shown that most HCC cas es arising in the area are due to HBV, HCV, or alcohol intake, in both the presence and absence of cirrhosis.