New insights on non-B non-C hepatocellular carcinoma in mid Delta Region, Egypt.
OBJECTIVE
The rate of hepatocellular carcinoma (HCC) is increasing worldwide, including in Egypt. Hepatitis B (HBV) and C (HCV) viruses are major risks. Non-B non-C HCC was reported in some countries. We investigated non-B non-C HCC-independent risk factors and associated profiles in viral hepatitis endemic region.


METHODS
In a consecutive series, 281 patients were diagnosed with HCC and received for management, at Tanta University Hospitals, within the past 3 years. Demographic variables and environmental exposures were recorded by direct application of a modified questionnaire. Sera were tested for HCV (antibodies by ELISA and RNA by RT-PCR) and HBV (HBs Ag by ELISA and HBV DNA). Antinuclear antibody, serum copper, and iron were assessed in non-viral HCC. Liver biopsy was performed for HCC diagnosis and grading and liver tissue in all patients by histopathological and immunohistochemical methods to assess HBV and/or HCV etiology.


RESULTS
Non-B non-C HCC patients were 13.87% of the total and were associated with multiple risks, predominantly pesticides (100%, p < 0.001) and super phosphate and ammonium sulfate fertilizers (94.87%, p < 0.001) with significant exposure in industry, farming, and residence. Their tumors were mainly solitary, smaller sizes, and of lower alpha-fetoprotein titers. The study showed insignificant increase in prevalence of non-B non-C HCC and had special characters. Multivariate analysis showed significance of pesticides and smoking as independent risks for non-B non-C HCC.


CONCLUSIONS
Pesticides and smoking heavy exposure can be considered as primary risks for non-B non-C HCC. Phosphate and ammonium sulfate fertilizers were associations. The study will increase awareness for better prevention and management.
Department of Tropical Medicine and Infectious Diseases, Faculty of Medicine, Tanta University, Tanta, Egypt, aaboalazm@gmail.com.
Abdel Raouf
AR
Abou El Azm
Mohamed
M
Yousef
Nagwa
N
Mansour
Aymen
A
Awad
Samia
S
El Dardiry
Ibrahim
I
Abdel Aziz
D000328:Adult; D000368:Aged; D000382:Agricultural Workers' Diseases / Q000139:chemically induced / Q000453:epidemiology / Q000209:etiology / Q000473:pathology; D000645:Ammonium Sulfate / Q000633:toxicity; D014408:Biomarkers, Tumor / Q000097:blood; D002274:Carcinogens, Environmental / Q000633:toxicity; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000139:chemically induced / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology; D016022:Case-Control Studies; D002617:Chemical Industry; D004534:Egypt / Q000453:epidemiology; D019353:Endemic Diseases; D004781:Environmental Exposure; D005260:Female; D005308:Fertilizers / Q000633:toxicity; D006508:Hepatitis Antibodies / Q000097:blood; D019694:Hepatitis B, Chronic / Q000453:epidemiology; D019698:Hepatitis C, Chronic / Q000453:epidemiology; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood / Q000139:chemically induced / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure; D010575:Pesticides / Q000633:toxicity; D010710:Phosphates / Q000633:toxicity; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data; D012907:Smoking / Q000009:adverse effects; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D000509:alpha-Fetoproteins / Q000032:analysis
C097353:AFP protein, human; D014408:Biomarkers, Tumor; D002274:Carcinogens, Environmental; D005308:Fertilizers; D006508:Hepatitis Antibodies; D010575:Pesticides; D010710:Phosphates; D000509:alpha-Fetoproteins; D000645:Ammonium Sulfate