Clinical and epidemiological aspects of hepatocellular carcinoma in Brazil

Abstract

OBJECTIVES:We performed a national survey to update hepatocellular carcinoma (HCC) epidemiology in Brazil and determined the clinical and epidemiological profiles of patients with HCC in different Brazilian regions.METHODS:Data from 29 centers included 1,405 patients diagnosed with HCC from 2004 to 2009.RESULTS:The median age was 59 (1–92 years old; 78% male). At diagnosis, females were older than males (median age: 62 vs. 59 years old respectively; p<0.0001). Ninety‐eight percent of the patients had cirrhosis (1279/1308). Hepatitis C virus was the main etiology (54%), followed by hepatitis B virus (16%) and alcohol (14%). In Southeastern and Southern Brazil, hepatitis C virus accounted for over 55% of cases. In the Northeast and North, hepatitis C virus accounted for less than 50%, and hepatitis B virus accounted for 22–25% of cases; hepatitis B was more prevalent in the Northern than in the Southern regions. Some 43%, 35%, and 22% of patients were in early, intermediate, and advanced stages respectively. Initial therapies for HCC included chemoembolization or embolization (36%), percutaneous ablation (13%), liver resection (7%), and sorafenib (1%). Liver transplantation was performed in 242 patients (19%), but it was the initial therapy for only 56 patients (4%).CONCLUSION:The epidemiology, classification, and therapy selection for HCC varied among Brazilian regions. Hepatitis C infection was the most common etiology of liver cirrhosis; chemoembolization was the most common therapy employed. Liver cirrhosis was the main risk factor for HCC development in Brazil.

Hepatitis virus and hepatocellular carcinoma in Brazil: a report from the State of Espírito Santo

“…Non-alcoholic steatohepatitis was identifi ed in 2.6% of cases, a prevalence similar to that reported in the last national survey 10,11 . An increased number of NASH-associated HCC has also been observed in more developed countries 26 , and it is possible that some cryptogenic cases may be related to unidentified NASH, instead, as has been hypothesized previously 5,27,28 .…”

“…However, the frequency of cirrhosis was lower than that reported for the second national survey 10,11 , in which cirrhosis was associated with 98% of cases. In case series of HCC from Minas Gerais 12 , no information on the frequency of associated liver cirrhosis is reported.…”

“…The results of the fi rst survey indicated that HBV was a common factor associated with HCC in the North and Northeast regions, whereas HCV was the main risk factor overall, especially in metropolitan areas in the South and Southeast regions 9 . The second survey yielded different results: HCV was found to be the main associated risk factor in all regions, but a high frequency of HBV-associated cases in the North, Central West and Northeast regions was also noted 10,11 . In a series of HCC cases that were diagnosed in Belo Horizonte, MG, the main associated factor was found to be HCV (44% of cases), while HBV infection was observed in 23.5% of cases 12 .…”

“…Risk factors associated with this form of cancer were reported in two national surveys, sponsored by the Brazilian Society of Hepatology, that were conducted in 1999 9 and 2010 10,11 , as well as in a series of cases from Minas Gerais (MG) 12 . The results of the fi rst survey indicated that HBV was a common factor associated with HCC in the North and Northeast regions, whereas HCV was the main risk factor overall, especially in metropolitan areas in the South and Southeast regions 9 .…”

“…In a series of HCC cases that were diagnosed in Belo Horizonte, MG, the main associated factor was found to be HCV (44% of cases), while HBV infection was observed in 23.5% of cases 12 . Associated liver cirrhosis has been reported at different frequencies in HCC cases in Brazil, ranging from 87% in the fi rst national survey 9 to 98% in the second survey 10,11 . Because Brazil is a large country and the environmental risk factors for HCC may vary across regions, we chose to examine the main associated risk factors in 274 cases of hepatocellular carcinoma diagnosed at the University Hospital in Vitória; we thus investigated HBV and HCV infections and chronic alcoholism in all cases.…”