Stroffolini T, Andreone P, Andriulli A, Ascione A, Craxi A, Chiaramonte M, Galante D, Manghisi O G, Mazzanti R, Medaglia C, Pilleri G, Rapaccini G L, Simonetti R G, Taliani G, Tosti M E, Villa E, Gasbarrini G
Laboratorio di Epidemiologia, ISS, Roma, Italy.
J Hepatol. 1998 Dec;29(6):944-52. doi: 10.1016/s0168-8278(98)80122-0.
BACKGROUND/AIMS: This study aimed to assess the main features of hepatocellular carcinoma at the time of diagnosis in Italy, particularly in relation to the presence or absence of underlying cirrhosis, hepatitis virus marker patterns, age of the subjects and alpha-foetoprotein values.
A total of 1148 patients with hepatocellular carcinoma seen at 14 Italian hospitals in the 1-year period from May 1996 to May 1997 were the subjects of this prevalence study. Both newly diagnosed cases (incident cases) and cases diagnosed before May 1996 but still attending the hospitals during the study period (prevalent cases) were included.
We found that 71.1% of cases were positive for hepatitis C virus antibodies but negative for HBsAg; in contrast, 11.5% were negative for anti-HCV but positive for HBsAg; 5.3% were positive for both markers; and 12.1% were negative for both viruses. The mean age of detection was over 60 years, with a younger mean age in HBsAg-positive compared to anti-HCV-positive patients (59.3 years vs. 65.6 years, p<0.01). The male-to-female ratio among HBsAg-positive patients was 10.4:1, in contrast to 2.8:1 among anti-HCV-positive patients (p<0.01). The majority of cases (93.1%) had underlying cirrhosis. Cirrhotic patients were more likely to be anti-HCV positive than non-cirrhotic cases (73.2% vs 43.9%; p<0.01); conversely, absence of hepatitis virus markers was more frequently observed in the non-cirrhotic than in the cirrhotic population (40.9% vs. 10.0%; p<0.01). Overall, the alpha-foetoprotein level was altered (>20 ng/ml) in 57.9% of patients; only 18% of cases presented diagnostic (>400 ng/ml) values. Anti-HCV positivity (O.R. 2.0; CI 95%=1.3-3.1) but not HBsAg positivity (O.R. 1.0; CI 95%=0.6-1.8) was shown to be an independent predictor of the likelihood of altered alpha-foetoprotein values by multivariate analysis.
These findings point to differences in the characteristics of the populations infected by hepatitis B and hepatitis C. Factors other than the hepatitis viruses are important in non-cirrhotic patients. A change in the relative prevalence of hepatitis virus markers among hepatocellular carcinoma cases was demonstrated, reflecting a significant change in the rate of HBV endemicity in the Italian population. Finally, the increased trend in the mortality rate from liver cancer in Italy from 4.8 per 100,000 in 1969 to 10.9 in 1994 may reflect the large cohort of subjects infected with HCV via the iatrogenic route during 1950s and 1960s when glass syringes were commonly used for medical treatment.
背景/目的：本研究旨在评估意大利肝细胞癌确诊时的主要特征，尤其是与潜在肝硬化的有无、肝炎病毒标志物模式、患者年龄及甲胎蛋白值的关系。
1996年5月至1997年5月这1年期间，在意大利14家医院就诊的1148例肝细胞癌患者是本患病率研究的对象。研究纳入了新确诊病例（现患病例）以及1996年5月之前确诊但在研究期间仍在医院就诊的病例（既往病例）。
我们发现，71.1%的病例丙肝病毒抗体呈阳性但乙肝表面抗原呈阴性；相比之下，11.5%的病例抗丙肝病毒呈阴性但乙肝表面抗原呈阳性；5.3%的病例两种标志物均呈阳性；12.1%的病例两种病毒均呈阴性。检测的平均年龄超过60岁，乙肝表面抗原阳性患者的平均年龄比抗丙肝病毒阳性患者小（59.3岁对65.6岁，p<0.01）。乙肝表面抗原阳性患者的男女比例为10.4:1，而抗丙肝病毒阳性患者为2.8:1（p<0.01）。大多数病例（93.1%）有潜在肝硬化。肝硬化患者抗丙肝病毒阳性的可能性高于非肝硬化病例（73.2%对43.9%；p<0.01）；相反，非肝硬化人群中无肝炎病毒标志物的情况比肝硬化人群更常见（40.9%对10.0%；p<0.01）。总体而言，57.9%的患者甲胎蛋白水平改变（>20 ng/ml）；仅18%的病例呈现诊断性（>400 ng/ml）值。多变量分析显示，抗丙肝病毒阳性（比值比2.0；95%置信区间=1.3 - 3.1）而非乙肝表面抗原阳性（比值比1.0；95%置信区间=0.6 - 1.8）是甲胎蛋白值改变可能性的独立预测因素。
这些发现表明乙肝和丙肝感染人群的特征存在差异。对于非肝硬化患者，除肝炎病毒外的其他因素也很重要。肝细胞癌病例中肝炎病毒标志物的相对患病率发生了变化，反映出意大利人群乙肝地方流行率的显著改变。最后，意大利肝癌死亡率从1969年的每10万人4.8例上升到1994年的10.9例，这一上升趋势可能反映了20世纪50年代和60年代玻璃注射器普遍用于医疗时，大量人群通过医源性途径感染丙肝病毒的情况。
