Etiology of hepatocellular carcinoma in Latin America: a prospective, multicenter, international study

Fassio, E; Díaz, Solangel Valdés; Santa, Catalina; Reig, María; Artola, Yamila Martínez; Mattos, Ângelo Alves de; Míguez, Carlos; Galizzi, J; Zapata, Rodrigo; Ridruejo, Ezequiel; Souza, Francisco Carlos de; Hernández, Nelia; Pinchuk, L

doi:10.1016/s1665-2681(19)31681-3

Cited by 59 publications

(42 citation statements)

References 31 publications

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“…Because Brazil is a country of continental proportions, the higher incidence detected in the South may be explained by geographic and/or racial heterogeneity, as well as specificities related to risk factors and access to health care services for screening, diagnosis, and follow-up. The predominance of the male sex and the mean age at diagnosis were similar to those described in other national[13,29,30] and international[12,31,32] studies.…”

Section: Discussionsupporting

confidence: 87%

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Incidence of hepatocellular carcinoma in outpatients with cirrhosis in Brazil: A 10-year retrospective cohort study

Silva¹,

Miozzo²,

Dossin³

et al. 2016

WJG

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AIMTo determine the incidence of hepatocellular carcinoma (HCC) and the impact of HCC surveillance on early diagnosis and survival of cirrhotic outpatients.METHODSIn this retrospective cohort study, cirrhotic outpatients undergoing HCC surveillance between March 2005 and March 2014 were analyzed. Exclusion criteria were HIV coinfection; previous organ transplantation; diagnosis of HCC at first consultation; missing data in the medical chart; and less than 1 year of follow-up. Surveillance was carried out every six months using ultrasound and serum alpha-fetoprotein determination. Ten-year cumulative incidence and survival were estimated through Kaplan-Meier analysis.RESULTSFour hundred and fifty-three patients were enrolled, of which 57.6% were male. Mean age was 55 years. Hepatitis C virus and heavy use of alcohol were the main etiologic agents of cirrhosis. HCC was diagnosed in 75 patients (16.6%), with an estimated cumulative incidence of 2.6% in the 1st year, 15.4% in the 5th year, and 28.8% in the 10th year. Median survival was estimated at 17.6 mo in HCC patients compared to 234 mo in non-HCC patients (P < 0.001). Early-stage HCC was more often detected in patients who underwent surveillance every 6 mo or less (P = 0.05). However, survival was not different between patients with early stage vs non-early stage tumors [HR = 0.54 (0.15-1.89), P = 0.33].CONCLUSIONHCC is a frequent complication in patients with cirrhosis and adherence to surveillance programs favors early diagnosis.

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Section: Discussionsupporting

confidence: 87%

“…In Latin America, limited data are available on the incidence and population characteristics of patients with HCC[12]. In Brazil, a national epidemiological survey sponsored by the Brazilian Society for Hepatology[13] evaluated 1405 patients with HCC in 29 centers across the country.…”

Section: Introductionmentioning

confidence: 99%

Incidence of hepatocellular carcinoma in outpatients with cirrhosis in Brazil: A 10-year retrospective cohort study

Silva¹,

Miozzo²,

Dossin³

et al. 2016

WJG

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“…The prevalence range of the serum anti-HCV marker was 32.8% to 44% in HCC cases from these South American countries [12–14]. Furthermore, in a recent prospective multicenter study of HCC cases from 9 Latin American countries, including Argentina, Brazil, Chile, Colombia, Uruguay, and Venezuela, the main HCC risk factor was HCV infection (30.8%), followed by alcohol (20.4%), HBV infection (10.8%), and HCV plus alcohol (5.8%) [6]. Some cases from this multicenter study corresponded to patients recruited in a prospective study carried out at Hospital Pablo Tobon Uribe (HPTU) in Medellin city; Interestingly, from the total 131 cases of end-stage liver disease in this hospital in the period of the study, the most important risk factor was chronic alcoholism (37.4%, 49/131), whereas viral infection ranked second (10.7% HBV and 6.9% HCV); the serum markers for diagnosis of viral infections were HBsAg and anti-HCV [51].…”

Section: Discussionmentioning

confidence: 99%

“…The first recent prospective study of HCC etiology in 9 Latin American countries showed that the primary risk factor was chronic HCV infection (30.8%), followed by chronic alcoholism (20.4%), and chronic HBV infection (10.8%) [6]. Although HCV infection is the most important HCC risk factor in Argentina, Mexico, and Brazil, regional differences have been described between northern and southern states in Brazil.…”

Section: Introductionmentioning

confidence: 99%

Hepatitis B and Hepatitis C Infection Biomarkers and TP53 Mutations in Hepatocellular Carcinomas from Colombia

Navas

Suarez

Carreño

et al. 2011

Hepatitis Research and Treatment

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Hepatocellular Carcinoma (HCC) is a leading cause of cancer-related death worldwide. Globally, the most important HCC risk factors are Hepatitis B Virus (HBV) and/or Hepatitis C Virus (HCV), chronic alcoholism, and dietary exposure to aflatoxins. We have described the epidemiological pattern of 202 HCC samples obtained from Colombian patients. Additionally we investigated HBV/HCV infections and TP53 mutations in 49 of these HCC cases. HBV biomarkers were detected in 58.1% of the cases; HBV genotypes F and D were characterized in three of the samples. The HCV biomarker was detected in 37% of the samples while HBV/HCV coinfection was found in 19.2%. Among TP53 mutations, 10.5% occur at the common aflatoxin mutation hotspot, codon 249. No data regarding chronic alcoholism was available from the cases. In conclusion, in this first study of HCC and biomarkers in a Colombian population, the main HCC risk factor was HBV infection.

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“…It is the leading cause of chronic hepatitis, cirrhosis, and hepatocellular carcinoma (HCC), as well as the most common indication for liver transplantation in Argentina and many other countries 1,2. It is estimated that 180 million people are infected worldwide,3 and more than half of them are not aware of their infection 4…”

Section: Introductionmentioning

confidence: 99%

Hepatitis C in Argentina: epidemiology and treatment

Gaite

Marciano

Galdame

et al. 2014

HMER

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Hepatitis C is the leading cause of chronic hepatitis, cirrhosis, and liver cancer in Argentina, where from 1.5% to 2.5% of adults are infected. Most of the infections were acquired 30–50 years ago. It is estimated that more than half of infected individuals are not aware of their infection. Even though the prevalence in blood donors has decreased to 0.45% at present, many high-prevalence populations still exist, where the reported prevalence ranges from 2.2% to 7.1%. Therapy is recommended for patients with fibrosis, in order to prevent disease progression, hepatic decompensation, and hepatocellular carcinoma. Great advances were achieved in the treatment of genotype 1 infection since the development and release of boceprevir and telaprevir. When either of these protease inhibitors is associated with peginterferon plus ribavirin, the sustained virological response (SVR) rate improves from 40%–50% to 67%–75%. For genotype 2 and 3 infection, treatment with peginterferon plus ribavirin is still the standard of care, with SVR rates of 70%–90%. There are significant new antivirals in development, and some of them are close to being released. These drugs will most likely be the future standard of care for all genotypes, and will be incorporated in better-tolerated and highly effective all-oral regimes. The impact that these new therapies might have in health-related economics is unpredictable, especially in developing countries. Each country must carefully evaluate the local situation in order to implement proper screening and treatment programs. Difficult-to-treat patients, such as those with decompensated cirrhosis, patients in hemodialysis, and those with other significant comorbidities, might not be able to receive these new therapeutic approaches and their management will remain challenging.

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Etiology of hepatocellular carcinoma in Latin America: a prospective, multicenter, international study

Cited by 59 publications

References 31 publications

Incidence of hepatocellular carcinoma in outpatients with cirrhosis in Brazil: A 10-year retrospective cohort study

Incidence of hepatocellular carcinoma in outpatients with cirrhosis in Brazil: A 10-year retrospective cohort study

Hepatitis B and Hepatitis C Infection Biomarkers and TP53 Mutations in Hepatocellular Carcinomas from Colombia

Hepatitis C in Argentina: epidemiology and treatment

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