title: Epidemiology of HCC in Brazil: incidence and risk factors in a ten-year cohort.
abstract: OBJECTIVE
  The lack of information about hepatocellular carcinoma (HCC) in Brazil weakens health policy in preventing deaths from the illness. The aim of this study was to establish the cumulative incidence and the risk factors for hepatocellular carcinoma development in patients under a surveillance program.
  
  
  METHODS
  884 patients with compensated cirrhosis were prospectively followed up for at least five years, from August 1998 until August 2008, with at least one annual ultrasonography liver examination and serum alpha fetoprotein (AFP) measurement.
  
  
  RESULTS
  Among 884 patients, 72 (8.1%) developed a tumor with a median follow up of 21.4 months. In the hepatocellular carcinoma group, hepatitis C virus infection was the major etiological factor (65.3%), 56.9% (41/72) were male and the mean average age was 57 ± 10 years. The annual incidence of hepatocellular carcinoma was 2.9%. 79.2% (57/72) of HCCs were detected within Milan Criteria, and the mean survival time was 52.3 months, significantly higher than for those outside Milan, with a mean time of 40.6 months (p = 0.0003).
  
  
  CONCLUSIONS
  The annual incidence of HCC among this large series of Brazilian cirrhotic patients was around 2.9% with a detection rate of 8.1%, or a cumulative incidence rate over five years of 14.3%. The three variables related to HCC risk were low serum albumin [HR: 0.518 (0.46-0.78)], high AFP > 20 ng/mL [HR: 3.16 (1.86-5.38)], and ethnicity (Brazilian-East Asian descendants vs. other mixed Brazilian ethnicities) [HR: 2.86 (1.48-5.53)].
authors.affiliation: São Paulo Clínicas Liver Cancer Group; Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, SP, Brazil.
authors.forename: Denise C
authors.initials: DC
authors.lastname: Paranaguá-Vezozzo
authors.affiliation: São Paulo Clínicas Liver Cancer Group; Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, SP, Brazil.
authors.forename: Suzane K
authors.initials: SK
authors.lastname: Ono
authors.affiliation: São Paulo Clínicas Liver Cancer Group; Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, SP, Brazil.
authors.forename: Mónica V
authors.initials: MV
authors.lastname: Alvarado-Mora
authors.affiliation: São Paulo Clínicas Liver Cancer Group; Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, SP, Brazil.
authors.forename: Alberto Q
authors.initials: AQ
authors.lastname: Farias
authors.affiliation: Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, SP, Brazil.
authors.forename: Marlone
authors.initials: M
authors.lastname: Cunha-Silva
authors.affiliation: Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, SP, Brazil.
authors.forename: João I D
authors.initials: JI
authors.lastname: França
authors.affiliation: São Paulo Clínicas Liver Cancer Group; Department of Pathology, University of São Paulo School of Medicine, São Paulo, SP, Brazil.
authors.forename: Venancio A F
authors.initials: VA
authors.lastname: Alves
authors.affiliation: Department of Gastroenterology, University of Toronto and University Health Network, Toronto, Canada.
authors.forename: Morris
authors.initials: M
authors.lastname: Sherman
authors.affiliation: São Paulo Clínicas Liver Cancer Group; Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, SP, Brazil.
authors.forename: Flair José
authors.initials: FJ
authors.lastname: Carrilho
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil / Q000453:epidemiology; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D015331:Cohort Studies; D005260:Female; D019694:Hepatitis B, Chronic / Q000150:complications / Q000453:epidemiology*; D019698:Hepatitis C, Chronic / Q000150:complications / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008099:Liver / Q000000981:diagnostic imaging; D008103:Liver Cirrhosis / Q000150:complications / Q000453:epidemiology; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications / Q000453:epidemiology*; D008113:Liver Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications / Q000453:epidemiology*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012709:Serum Albumin; D014463:Ultrasonography; D055815:Young Adult; D000509:alpha-Fetoproteins / Q000378:metabolism
chemical_list: D012709:Serum Albumin; D000509:alpha-Fetoproteins