Department of Surgery, Geisinger Medical Center, Danville, PA 17822, USA.
Liver Int. 2011 Feb;31(2):215-21. doi: 10.1111/j.1478-3231.2010.02418.x. Epub 2010 Dec 8.
Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide, with a high burden in West Africa. Data evaluating aetiological differences in HCC presentation from this region are limited.
The aim of this study was to describe the demographical, clinical and pathological characteristics of HCC by aetiology (hepatitis B or C infection, aflatoxin associated).
One hundred and ninty-three cases of HCC diagnosed between 1997 and 2001 in The Gambia were analysed. Characteristics were compared by aetiology using χ(2)-tests, student t-test and Wilcoxon's rank sum tests as appropriate.
The prevalence of hepatitis B surface antigen, hepatitis C antibody and aflatoxin-associated 249(ser) TP53 mutations among HCC patients was 60, 20 and 38% respectively. The typical HCC patient was a 49-year-old male positive for hepatitis B surface antigen presenting with hepatomegaly (93%), abdominal pain (94%) and weight loss (95%) 8 weeks after symptom onset. Most patients had multifocal lesions with background cirrhosis. The median largest tumour was 10.3 cm and the median α-fetoprotein level was 500 ng/ml. Eighty-four per cent of patients had advanced HCC (patients not meeting the Milan criteria) at presentation.
Irrespective of aetiological agent, HCC among West Africans presents at very advanced stages. Few clinical or pathological differences exist by aetiology. More studies are needed to understand the mechanisms of hepatocarcinogenesis among these patients as well as identify high-risk populations in which early detection through screening will be beneficial.
肝细胞癌（HCC）是全球最常见的恶性肿瘤之一，在西非负担沉重。评估该地区 HCC 表现病因学差异的数据有限。
本研究旨在通过病因（乙型肝炎或丙型肝炎感染、黄曲霉毒素相关）描述 HCC 的人口统计学、临床和病理学特征。
分析了 1997 年至 2001 年间在冈比亚诊断的 193 例 HCC 病例。使用 χ(2)检验、学生 t 检验和 Wilcoxon 秩和检验比较病因学特征。
HCC 患者中乙型肝炎表面抗原、丙型肝炎抗体和黄曲霉毒素相关 249(ser)TP53 突变的患病率分别为 60%、20%和 38%。典型的 HCC 患者是一名 49 岁男性，乙型肝炎表面抗原阳性，出现肝肿大（93%）、腹痛（94%）和体重减轻（95%），症状出现后 8 周。大多数患者有背景肝硬化的多灶性病变。最大肿瘤的中位数为 10.3 厘米，α-胎蛋白水平的中位数为 500ng/ml。84%的患者在就诊时患有晚期 HCC（不符合米兰标准的患者）。
无论病因如何，西非的 HCC 都处于非常晚期。病因学上的临床或病理学差异不大。需要进一步研究以了解这些患者的肝癌发生机制，并确定通过筛查将受益的高危人群。
