title: Cirrhosis and Chronic Viral Hepatitis as Risk Factors for Hepatocellular Carcinoma: Romanian Single-clinic Experience.
abstract: BACKGROUND
  Hepatocellular carcinoma (HCC) represents the fifth most common cancer worldwide, while being the third leading cause of death by cancer. The primary risk factor for HCC seems to be liver cirrhosis. A large majority of these patients have a history of viral hepatitis.
  
  
  METHODS
  We selected a study lot consisting of 244 patients diagnosed with HCC, admitted between 2006 and October 2009 in the Emergency County Hospital of Craiova, Romania along with an age and gender matched control group, consisting of patients with no history of HCC or other malignancies. We interviewed all subjects regarding their alcohol consumption and background environment. All subjects underwent hepatitis B surface antigen (Hbs Ag) and anti-HCV antibodies (Anti-HCV Atb) serological determinations.
  
  
  RESULTS
  The study group consisted of 148 males and 96 females. Liver cirrhosis (LC) was present in 84% of the study lot, 10% associated viral B hepatitis (HBV) and 6% viral C hepatitis (HCV), with no signs of LC. We found LC to be an important risk factor for HCC (RR 6.53, CI 95% 3.18-13.38). The RR and 95% CI of HCC were 4.51 (2.48-8.21) for HbsAg positivity. We noticed a strong correlation (Chi-square test, p<0.001) between the rural environment and the association with LC. HVB was also more present in patients coming from rural areas (p< 0.01). Alcohol intake was present in 89% of the whole lot, being more correlated with the presence of LC as well as with HbsAg positivity (RR 9.165, CI 95% 4.43-18.92).
  
  
  CONCLUSIONS
  Cirrhosis proved to be the primary risk factors for HCC. We underline the fact that HCC was found to be directly associated with viral hepatitis, without evident LC. Further studies are needed in order to establish if intensified HCC screening, especially in rural areas, is required in patients with newly diagnosed viral hepatitis. The increased prevalence of HBV infections might encourage HBV vaccinations as an efficient tool to prevent HCC.
authors: University of Medicine and Pharmacy of Craiova, Emergency County Hospital of Craiova, Romania.
authors: Cristin Vere
authors: CV
authors: Constantin
authors: Costin Teodor
authors: CT
authors: Streba
authors: Ion
authors: I
authors: Rogoveanu
authors: Liliana
authors: L
authors: Nita-Stefanescu
authors: Alin Gabriel
authors: AG
authors: Ionescu