24
views
0
recommends
+1 Recommend
1 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Epidemiología del carcinoma hepatocelular en un área rural: Papel de los virus hepatotropos en la supervivencia Translated title: Epidemiology of hepatocellular carcinoma in a rural area: Role of hepatotrophic viruses on survival

      research-article

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Introducción: Las hepatitis crónicas C y B son las principales causas de carcinoma hepatocelular (CHC) en el mundo. No se sabe si la infección crónica por los virus de la hepatitis C (VHC) o B (VHB) es un factor pronóstico para el CHC. El presente estudio busca conocer la epidemiología del CHC en un área de salud rural y valorar si la infección crónica por los VHC o VHB tiene algún impacto en la supervivencia tras el diagnóstico de CHC. Material y métodos: Estudio retrospectivo de 51 pacientes consecutivos, diagnosticados de CHC entre enero de 1994 y diciembre de 2002 en un Hospital de Primer Nivel. Se analizaron las siguientes variables: edad, sexo, infección por VHC y VHB, abuso crónico de alcohol (toma diaria mayor de 80 g), presentación clínica, estadio de Child, número de nódulos hepáticos, tratamiento y supervivencia. Resultados: La edad media al diagnóstico de CHC fue de 68,5 años de edad (rango 45-90) y 45 pacientes (88,6%) eran varones. Los factores etiológicos más prevalentes fueron la ingestión excesiva de alcohol (66%) y la infección crónica por el VHC (42,8%). La infección crónica por el VHB se halló en el 11,9%. En el 48,9% de los casos se detectó infección crónica por el VHC o por el VHB. El 25% estaban asintomáticos y el 66% en estadio A de Child. La proporción lesión única / CHC multinodular fue 52/48. Únicamente el 6% de los pacientes pudo recibir tratamiento con intención curativa. La supervivencia media fue de 10,9 ± 9,1 meses, y no hubo diferencias respecto a la edad, sexo, estadio de Child y número de nódulos hepáticos. La supervivencia fue significativamente mayor en los pacientes con infección crónica por el VHC o por el VHB (16,7 ± 13,1 frente a 4,75 ± 5,3 meses en seronegativos; p=0.02). En el análisis multivariante, sólo la infección crónica por el VHC o por VHB se asoció con una supervivencia superior a 10 meses (OR 22,3; IC 95% 1,8-277,9). Conclusiones: En nuestro medio, los factores etiológicos más prevalentes del CHC son el etilismo y la infección por el VHC. En pacientes con CHC, la infección crónica por el VHC o por el VHB se asocia a una mayor supervivencia.

          Translated abstract

          Background: Chronic hepatitis C and B are the main causes of hepatocellular carcinoma (HCC) worldwide. It is not clear whether chronic hepatitis C or B virus (HCV or HBV) infection is a prognostic factor for HCC. This study aimed to asses epidemiology of HCC in a rural area and to determine if chronic HCV or HBV infection had any impact on survival after the diagnosis of HCC. Material and methods: Fifty-one consecutive patients were retrospectively studied. All of them were diagnosed of HCC between january 1994 and december 2002 in a First Level Hospital. The following variables were analysed: age, sex, HCV and HBV infection, chronic alcohol abuse (daily intake upper 80 g), clinical presentation, Child stage, number ol liver nodules, therapeutic options and survival. Results: The mean age at diagnosis of HCC was 68,5 years old (age range 45-90) and 45 patients (88,6%) were male. Heavy alcohol intake (66%) and chronic HCV infection (42,8%) were the most prevalent etiologic factors. Chronic HBV was found in 11,9%. Chronic HCV or HBV infection was present in 48,9%. Twenty-five percent were asymptomatic and 66% were in Child stage A. The rate single lesion / multilobular HCC was 52/48. Only 6% of all patients could be treated with a curative intention. The mean survival was 10,9 ± 9,1 months, and there were no differences in age, sex, Child stage and number of nodules. There was a significantly higher survival in patients with chronic HCV or HBV infection (16,7 ± 13,1 months versus 4,75 ± 5,3 months in seronegative patients; p=0.02). On multivariate analysis, only chronic HCV or HBV infection was associated with survival longer than 10 months (OR 22,3; CI 95% 1,8-277,9). Conclusions: In our area, heavy alcohol abuse and HCV infection were the most prevalent etiologic factors of HCC. Chronic HCV or HBV infection was associated with longer survival in patientes with HCC.

          Related collections

          Most cited references40

          • Record: found
          • Abstract: not found
          • Article: not found

          Prognostic prediction and treatment strategy in hepatocellular carcinoma.

            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Epidemiology of primary liver cancer.

            Liver cancer (LC) ranks fifth in frequency in the world with an estimated number of 437,000 new cases in 1990. In developing countries, incidence rates are two- to three-fold higher than in developed countries. The geographic areas at highest risk are located in Eastern Asia, with age-adjusted incidence rates (AAIRs) ranking from 27.6 to 36.6 per 100,000 in men; Middle Africa, with AAIRs ranking from 20.8 to 38.1 per 100,000 in men; and some countries of Western Africa, with AAIRs ranking from 30 to 48 per 100,000 in men. The geographic areas at lowest LC risk are Northern Europe, Australia, New Zealand, and the Caucasian populations in North and Latin America, with AAIRs below 5.0 per 100,000 in men. Excess of LC incidence among men compared to women is universal, with sex ratios between 1.5 and 3.0. Significant variations in LC incidence among different ethnic groups living in the same geographical area and among migrants of the same ethnic groups living in different areas have been extensively described. The variability of LC incidence rates between countries and within countries, strongly suggests differences in exposure to risk factors. The role of chronic infection with the Hepatitis B and hepatitis C viruses (HBV and HCV) in the etiology of LC is well established. The attributable risk estimates for LC for each of these hepatotropic viruses vary among countries but the combined effects of persistent HBV or HCV infections account for well over 80% of LC cases worldwide. Other documented risk factors such as aflatoxin exposure in diets, cigarette smoking, alcohol consumption, and oral contraceptives may explain the residual variation between and within countries. Interactions between some risk factors have been postulated, and are subject of active research. New laboratory techniques and biological markers such as polymerase chain reaction detection of HBV DNA and HCV RNA, as well as specific mutations related to aflatoxin exposure may help to provide quantitative estimates of the risk related to each these factors.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Hepatocellular carcinoma.

              K Okuda (2000)
              Hepatocellular carcinoma (HCC) is increasing in many countries as a result of an increase in hepatitis C virus (HCV) infection since World War II. The epidemiology of HCC varies with the global region. There have been conflicting observations from different parts of the world concerning the frequency of HCC in patients who in the distant past had post-transfusion non-A, non-B hepatitis. The genetic basis of hepatocarcinogenesis is still poorly understood. In hepatitis B virus (HVB) associated HCC, codon 249 mutation in the p 53 gene seems more related to exposure to aflatoxin B1 than to hepatocarcinogenesis itself. HCC that occurs in children in high HBV endemic regions could be associated with germ-line mutations, but little information is available; not much is known about chemical hepatocarcinogens in the environment other than aflatoxins. The X gene of HBV seems to play an important role in HBV-associated hepatocarcinogenesis. There are preliminary observations on the molecular mechanism of HCV-associated HCC, such as HCV core protein inducing HCC in transgenic mice and the NS3 genome transforming NIH 3T3 cells. Pathological distinction between preneoplastic and very early transformed lesions still depends on classical morphology, and a more genetically oriented differential diagnosis is required. Clinical diagnosis based on modern imaging has improved greatly, but is still unsatisfactory in the differential diagnosis of preneoplastic and early transformed nodules, because the vasculature changes that occur within the nodule are not accurately discerned with the current imaging. Use of sensitive des-gamma-carboxy prothrombin (PIVKA II) assay, and lectin affinity chromatography separating HCC specific subspecies of AFP molecules with a more practical biochemical technique will further improve diagnosis. Early diagnosis and transplantation are the best treatment at the moment, but transplantation is not widely available because of the donor shortage. Despite successful resection, the remnant cirrhotic liver frequently develops new HCC lesions, seriously curtailing long-term survival. All-out efforts should be directed to the prevention of HCC, through prevention of viral hepatitis, prevention of acute hepatitis from becoming chronic, prevention of chronic hepatitis from progressing to cirrhosis, and prevention of the cirrhotic liver from developing HCC (chemoprevention). At the moment, very few such studies exist.
                Bookmark

                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                ami
                Anales de Medicina Interna
                An. Med. Interna (Madrid)
                Arán Ediciones, S. L. (, , Spain )
                0212-7199
                April 2005
                : 22
                : 4
                : 10-14
                Affiliations
                [01] orgnameHospital de Llerena orgdiv1Servicio de Medicina Interna
                [02] Llerena Badajoz orgnameHospital de Llerena orgdiv1Servicio de Análisis Clínicos
                Article
                S0212-71992005000400002
                10.4321/s0212-71992005000400002
                d98fbf18-f341-4aca-93d1-7f80a7c3fa99

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 28, Pages: 5
                Product

                SciELO Spain


                Virus de la hepatitis B,Supervivencia,Hepatocellular carcinoma,Hepatitis C virus,Hepatitis B virus,Survival,Carcinoma hepatocelular,Virus de la hepatitis C

                Comments

                Comment on this article