title: Clinical and epidemiological aspects of hepatocellular carcinoma in Brazil.
abstract: OBJECTIVE
  We performed a national survey to update hepatocellular carcinoma (HCC) epidemiology in Brazil and determined the clinical and epidemiological profiles of patients with HCC in different Brazilian regions.
  
  
  METHODS
  Data from 29 centers included 1,405 patients diagnosed with HCC from 2004 to 2009.
  
  
  RESULTS
  The median age was 59 (1-92 years old; 78% male). At diagnosis, females were older than males (median age: 62 vs. 59 years old respectively; p<0.0001). Ninety-eight percent of the patients had cirrhosis (1279/1308). Hepatitis C virus was the main etiology (54%), followed by hepatitis B virus (16%) and alcohol (14%). In Southeastern and Southern Brazil, hepatitis C virus accounted for over 55% of cases. In the Northeast and North, hepatitis C virus accounted for less than 50%, and hepatitis B virus accounted for 22-25% of cases; hepatitis B was more prevalent in the Northern than in the Southern regions. Some 43%, 35%, and 22% of patients were in early, intermediate, and advanced stages respectively. Initial therapies for HCC included chemoembolization or embolization (36%), percutaneous ablation (13%), liver resection (7%), and sorafenib (1%). Liver transplantation was performed in 242 patients (19%), but it was the initial therapy for only 56 patients (4%).
  
  
  CONCLUSIONS
  The epidemiology, classification, and therapy selection for HCC varied among Brazilian regions. Hepatitis C infection was the most common etiology of liver cirrhosis; chemoembolization was the most common therapy employed. Liver cirrhosis was the main risk factor for HCC development in Brazil.
authors.affiliation: Department of Gastroenterology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil. fjcarril@usp.br
authors.forename: Flair Jose
authors.initials: FJ
authors.lastname: Carrilho
authors.forename: Luciana
authors.initials: L
authors.lastname: Kikuchi
authors.forename: Fernanda
authors.initials: F
authors.lastname: Branco
authors.forename: Carlos Sandoval
authors.initials: CS
authors.lastname: Goncalves
authors.forename: Angelo Aves de
authors.initials: AA
authors.lastname: Mattos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil / Q000453:epidemiology; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D005260:Female; D006306:Health Surveys / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008113:Liver Neoplasms / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D055815:Young Adult