Epidemiology of hepatocellular carcinoma. Evaluation of viral and other risk factors in a low-endemic area for hepatitis B and C.

To assess whether hepatocellular carcinoma (HCC) in patients with cirrhosis of the liver is associated with particular risk factors, a retrospective, case-control study was performed. Eighty-six patients with HCC (90% had underlying cirrhosis of the liver) were compared with 86 controls who had cirrhosis but not hepatocellular carcinoma. Hepatitis B surface antigen (HBsAg), antibodies to hepatitis B core antigen (anti-HBc), and to hepatitis C virus (anti-HCV) were evaluated; and alcohol and nicotine abuse were assessed by history. The prevalence of HBsAg and anti-HBc was similar in both, case and control patients. Antibodies to hepatitis C virus were detected more frequently among patients with HCC and cirrhosis (37%) compared to cirrhosis alone (22%). Alcohol abuse was found more frequently in patients with cirrhosis alone. Smoking habits were comparable between the two groups. None of the tested variables were related to an increased risk for HCC. Using an ordinary logistic regression approach, none of the variables could be identified as an independent risk factor for HCC. However, the combination of hepatitis B virus infection and hepatitis C virus infection was more prevalent in the patients with hepatocellular carcinoma and cirrhosis (48%) when compared to patients with cirrhosis alone (13%) (odds ratio 6.364; CI 1.149-35.229). In conclusion, we failed to identify independent risk factors for the development of HCC in Germany. However, the combination of hepatitis B and C virus infection increases the risk for liver cancer. Molecular analyses have to be performed to elucidate viral hepatocarcinogenesis.