Giarelli L, Melato M, Zanconati F, Musse M M, Laurino L, Okuda K, Kojiro M
Institute of Pathological Anatomy, University of Trieste, Italy.
J Gastroenterol Hepatol. 1991 May-Jun;6(3):278-82. doi: 10.1111/j.1440-1746.1991.tb01478.x.
This study, aimed at elucidating the epidemiological features of primary liver carcinoma developing in non-cirrhotic livers, was based on 25,103 autopsies performed between 1975 and 1984 in Trieste, Italy. These autopsies correspond to approximately 70% of all deaths that occurred in this area. Various factors allegedly related to carcinomas were analysed in reference to our previous study on cirrhotic livers and in comparison with 5,603 autopsies in Kurume, Japan. There were 28 cases of hepatocellular carcinoma (HCC), 16 of cholangiocellular carcinoma (CCC) not associated with cirrhosis in Trieste, and 48 HCC and 19 CCC in Kurume. On the basis of our findings, it was concluded that cirrhosis, regardless of its cause, is the main pathogenetic factor in HCC; it is responsible for a much higher frequency (14.2:1) than in non-cirrhotic livers, as well as for early occurrence of tumours (an average of 6 years earlier in cirrhotic liver) in Trieste. Patients in Trieste were older than those in Japan, and the frequency of HCC among all autopsies was much greater in the latter. By contrast, the influence of cirrhosis on cholangiocellular carcinoma (CCC) was negligible, as such association appeared purely coincidental or absent. The incidence of CCC among autopsies was greater in Japan. Our data on CCC were not sufficient to demonstrate any clear aetiopathogenetic association between this tumour and alcohol abuse and hepatitis B virus (HBV) infection, except for a possible aetiological role of gallstones. The frequency of CCC relative to HCC was greater in Trieste than in Japan; the incidence of HCC was much less in Trieste, whereas CCC was more frequent in Japan.
本研究旨在阐明非肝硬化肝脏中原发性肝癌的流行病学特征，以1975年至1984年在意大利的里雅斯特进行的25103例尸检为基础。这些尸检约占该地区所有死亡人数的70%。参考我们之前关于肝硬化肝脏的研究，并与日本久留米的5603例尸检进行比较，分析了各种据称与癌症相关的因素。在的里雅斯特有28例肝细胞癌（HCC），16例胆管细胞癌（CCC）与肝硬化无关，在久留米有48例HCC和19例CCC。根据我们的研究结果得出结论，无论病因如何，肝硬化都是HCC的主要致病因素；在的里雅斯特，它导致的HCC发生率比非肝硬化肝脏高得多（14.2:1），且肿瘤发生更早（肝硬化肝脏平均早6年）。的里雅斯特的患者比日本的患者年龄更大，后者在所有尸检中HCC的发生率更高。相比之下，肝硬化对胆管细胞癌（CCC）的影响可忽略不计，因为这种关联似乎纯属偶然或不存在。日本尸检中CCC的发生率更高。我们关于CCC的数据不足以证明该肿瘤与酒精滥用和乙型肝炎病毒（HBV）感染之间有任何明确的病因学关联，除了胆结石可能的病因学作用。在的里雅斯特，CCC相对于HCC的发生率比日本更高；的里雅斯特HCC的发生率低得多，而日本CCC更常见。
