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Abstract
Background:
Chronic hepatitis B virus (HBV) infection and cirrhosis are major risk factors for the development of hepatocellular carcinoma (HCC). In Cameroon, which is a highly endemic zone for HBV, its epidemiologic characteristics are not known. The aim of our study was to determine the epidemiologic characteristics of hepatitis B-associated HCC in our milieu for a better management of the disease.
Methods:
Patients suffering from HCC in two hospitals in Yaounde were sampled and screened for HBV, HCV and HDV. Only HBV related HCC were enrolled. Demographic characteristics, presence or not of cirrhosis, excessive alcohol consumption (>80g/day) and smoking were analyzed.
Results:
A total of 34 cases of HCC were identified. The mean age was 38.5±12.3years (extremes 18 – 74 years); 79.4% (27/34) were males (sex ratio 3.9:1); 55.9% (19/34) had cirrhosis while 44.1% (15/34) were non cirrhotic. Also, 44.1% (15/34) were smokers and 2.9% (1/34) were alcoholics. The prevalence of HCC was 14.7%, 47.7%, 20.6%, 11.8% and 5.9% amongst those below 30 years, 30–39 years, 40–49 years, 50–59 years and 60 years and above respectively. There was no statistically significant difference between the mean ages of cirrhotic and non cirrhotic patients (38.9±11.3 vs. 38.0±14 years, p=0.08). The majority of patients below 30 years had no cirrhosis at the moment the diagnosis of HCC was made (80% vs. 39.9%, p=0.08). Cirrhosis was more frequent amongst those aged 30–39 years (68.8% vs. 44.4%, p=0.16). There was no other difference between cirrhotic and non cirrhotic patients. Neither alcohol nor smoking had no a synergic effect in the development of HCC.
Conclusion:
Most patients with hepatitis B-associated HCC in Cameroon are aged below 40 years. Cirrhosis is not always present at diagnosis. The epidemiologic profiles of cirrhotic and non cirrhotic patients are similar. The influence of alcohol and tobacco is negligible. The introduction of HBV vaccine in the extended immunization program in 2005 was thus necessary in our country.
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References
- References:
- Sinclair M, Roberts S, Kemp W, Knight V, Dev A, Gow P, Philpott H, Kronborg I, Arachchi N, Bell S, Lim L, Gorelik A, Nicoll A; Melbourne collaboration for the study of Hepatocellular carcinoma. Epidemiology of Hepatitis B-associated Hepatocellular Carcinoma in Victoria. Intern Med J. 2012 Dec 24. doi: 10.1111/imj.12068.
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- Wild CP, Hall AJ. Primary prevention of hepatocellular carcinoma in developing countries. Mutat Res. 2000 Apr; 462(2-3):381-93.
- Lodato F, Mazzella G, Festi D, Azzaroli F, Colecchia A, Roda E. Hepatocellular carcinoma prevention: a worldwide emergence between the opulence of developed countries and the economic constraints of developing nations. World J Gastroenterol. 2006 Dec 7; 12(45):7239-49.
- Chang MH. Cancer prevention by vaccination against hepatitis B. Recent Results Cancer Res. 2009; 181:85-94.
- Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin. 2005; 55:74–108.
- Montalto G, Cervello M, Giannitrapani L, Dantona F, Terranova A, Castagnetta LA. Epidemiology, risk factors, and natural history of hepatocellular carcinoma. Ann N Y Acad Sci. 2002 Jun; 963:13-20.
- Stroffolini T. Etiological factor of hepatocellular carcinoma in Italy. Minerva Gastroenterol Dietol. 2005 Mar; 51(1):1-5.
- Asia-Pacific Working Party on Prevention of Hepatocellular Carcinoma. Prevention of hepatocellular carcinoma in the Asia-Pacific region: consensus statements. J Gastroenterol Hepatol. 2010 Apr; 25(4):657-63. doi: 10.1111/j.1440-1746.2009.06167.x.
- David Yiu-Kuen But, Ching-Lung Lai, and Man-Fung Yuen Natural history of hepatitis-related hepatocellular carcinoma World J Gastroenterol. 2008 March 21; 14(11): 1652–1656. doi: 10.3748/wjg.14.1652.
- Michielsen PP, Francque SM, van Dongen JL. Viral hepatitis and hepatocellular carcinoma. World J Surg Oncol. 2005 May 20; 3:27.
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- Rodríguez-Vidigal FF, Baz MJ, Romero J, Del Puerto M. Epidemiology of hepatocellular carcinoma in a rural area. Role of hepatotrophic viruses on survival. An Med Interna. 2005 Apr; 22(4):162-6.
- Monto A, Wright TL. The epidemiology and prevention of hepatocellular carcinoma. Semin Oncol. 2001 Oct; 28(5):441-9.
- Wan DW, Tzimas D, Smith JA, Kim S, Araujo J, David R, Lobach I, Sarpel U. Risk factors for early-onset and late-onset hepatocellular carcinoma in Asian immigrants with hepatitis B in the United States. Am J Gastroenterol. 2011 Nov; 106(11):1994-2000. doi: 10.1038/ajg.2011.302.
- Anwar WA, Khaled HM, Amra HA, El-Nezami H, Loffredo CA. Changing pattern of hepatocellular carcinoma (HCC) and its risk factors in Egypt: possibilities for prevention. Mutat Res. 2008 Jul-Aug; 659(1-2):176-84. doi: 10.1016/j.mrrev.2008.01.005.
- Institut National de la Statistique du Cameroun. « Etat et structure de la population=indicateurs démographiques » 2010, p.6.
- Kumar M, Kumar R, Hissar SS, Saraswat MK, Sharma BC, Sakhuja P, Sarin SK. Risk factors analysis for hepatocellular carcinoma in patients with and without cirrhosis: a case-control study of 213 hepatocellular carcinoma patients from India. J Gastroenterol Hepatol. 2007 Jul; 22(7):1104-11.
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References
References:
Sinclair M, Roberts S, Kemp W, Knight V, Dev A, Gow P, Philpott H, Kronborg I, Arachchi N, Bell S, Lim L, Gorelik A, Nicoll A; Melbourne collaboration for the study of Hepatocellular carcinoma. Epidemiology of Hepatitis B-associated Hepatocellular Carcinoma in Victoria. Intern Med J. 2012 Dec 24. doi: 10.1111/imj.12068.
Zidan A, Scheuerlein H, Schüle S, Settmacher U, Rauchfuss F. Epidemiological pattern of hepatitis B and hepatitis C as etiological agents for hepatocellular carcinoma in iran and worldwide. Hepat Mon. 2012 Oct; 12(10 HCC):e6894. doi: 10.5812/hepatmon.6894.
Wild CP, Hall AJ. Primary prevention of hepatocellular carcinoma in developing countries. Mutat Res. 2000 Apr; 462(2-3):381-93.
Lodato F, Mazzella G, Festi D, Azzaroli F, Colecchia A, Roda E. Hepatocellular carcinoma prevention: a worldwide emergence between the opulence of developed countries and the economic constraints of developing nations. World J Gastroenterol. 2006 Dec 7; 12(45):7239-49.
Chang MH. Cancer prevention by vaccination against hepatitis B. Recent Results Cancer Res. 2009; 181:85-94.
Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin. 2005; 55:74–108.
Montalto G, Cervello M, Giannitrapani L, Dantona F, Terranova A, Castagnetta LA. Epidemiology, risk factors, and natural history of hepatocellular carcinoma. Ann N Y Acad Sci. 2002 Jun; 963:13-20.
Stroffolini T. Etiological factor of hepatocellular carcinoma in Italy. Minerva Gastroenterol Dietol. 2005 Mar; 51(1):1-5.
Asia-Pacific Working Party on Prevention of Hepatocellular Carcinoma. Prevention of hepatocellular carcinoma in the Asia-Pacific region: consensus statements. J Gastroenterol Hepatol. 2010 Apr; 25(4):657-63. doi: 10.1111/j.1440-1746.2009.06167.x.
David Yiu-Kuen But, Ching-Lung Lai, and Man-Fung Yuen Natural history of hepatitis-related hepatocellular carcinoma World J Gastroenterol. 2008 March 21; 14(11): 1652–1656. doi: 10.3748/wjg.14.1652.
Michielsen PP, Francque SM, van Dongen JL. Viral hepatitis and hepatocellular carcinoma. World J Surg Oncol. 2005 May 20; 3:27.
Yuen MF, Hou JL, Chutaputti A; Asia Pacific Working Party on Prevention of Hepatocellular Carcinoma. Hepatocellular carcinoma in the Asia pacific region. J Gastroenterol Hepatol. 2009 Mar; 24(3):346-53. doi: 10.1111/j.1440-1746.2009.05784.x.
El-Serag HB. Hepatocellular carcinoma: an epidemiologic view. J Clin Gastroenterol. 2002 Nov-Dec; 35(5 Suppl 2):S72-8.
Rodríguez-Vidigal FF, Baz MJ, Romero J, Del Puerto M. Epidemiology of hepatocellular carcinoma in a rural area. Role of hepatotrophic viruses on survival. An Med Interna. 2005 Apr; 22(4):162-6.
Monto A, Wright TL. The epidemiology and prevention of hepatocellular carcinoma. Semin Oncol. 2001 Oct; 28(5):441-9.
Wan DW, Tzimas D, Smith JA, Kim S, Araujo J, David R, Lobach I, Sarpel U. Risk factors for early-onset and late-onset hepatocellular carcinoma in Asian immigrants with hepatitis B in the United States. Am J Gastroenterol. 2011 Nov; 106(11):1994-2000. doi: 10.1038/ajg.2011.302.
Anwar WA, Khaled HM, Amra HA, El-Nezami H, Loffredo CA. Changing pattern of hepatocellular carcinoma (HCC) and its risk factors in Egypt: possibilities for prevention. Mutat Res. 2008 Jul-Aug; 659(1-2):176-84. doi: 10.1016/j.mrrev.2008.01.005.
Institut National de la Statistique du Cameroun. « Etat et structure de la population=indicateurs démographiques » 2010, p.6.
Kumar M, Kumar R, Hissar SS, Saraswat MK, Sharma BC, Sakhuja P, Sarin SK. Risk factors analysis for hepatocellular carcinoma in patients with and without cirrhosis: a case-control study of 213 hepatocellular carcinoma patients from India. J Gastroenterol Hepatol. 2007 Jul; 22(7):1104-11.
Fattovich G, Stroffolini T, Zagni I, Donato F. Hepatocellular carcinoma in cirrhosis: incidence and risk factors. Gastroenterology. 2004 Nov; 127(5 Suppl 1):S35-50.