title: Hepatitis virus and hepatocellular carcinoma in Brazil: a report from the State of Espírito Santo.
abstract: BACKGROUND
  Few studies have examined hepatocellular carcinoma (HCC) in Brazil, and the incidence and risk factors for this type of malignancy vary greatly geographically. In this paper, we report several risk factors associated with HCC diagnosed at the University Hospital in Vitória, ES, Brazil.
  
  
  METHODS
  We reviewed 274 cases of HCC (January 1993 to December 2011) in which hepatitis B (HBV) and C (HCV) virus infection and chronic alcoholism were investigated. A diagnosis of hepatocellular carcinoma was confirmed by histology or by the presence of a characteristic pattern on imaging.
  
  
  RESULTS
  HCC with associated liver cirrhosis was noted in 85.4% of cases. The mean ages of men and women were 56.6 years and 57.5 years, respectively. The male-to-female ratio was 5.8:1. Associated risk factors included the following: HBV, 37.6% (alone, 23.4%; associated with chronic alcoholism, 14.2%); HCV, 22.6% (alone, 13.5%; associated with chronic alcoholism, 9.1%), chronic alcoholism, 17.1%, non-alcoholic steatohepatitis, 2.6% and cryptogenic, 19.3%. The male-to-female ratio was higher in cases associated with HBV or chronic alcoholism compared with HCV-associated or cryptogenic cases. In 40 cases without associated cirrhosis, the male-to-female ratio and mean age were lower than those in cirrhosis-associated cases.
  
  
  CONCLUSIONS
  These results demonstrate that the main risk factor associated with HCC in the State of Espírito Santo is HBV. Chronic alcoholism is an important etiological factor, alone or in association with HBV or HCV infection.
authors.affiliation: Hospital Universitário Cassiano Antonio de Morais, Universidade Federal do Espírito Santo, Vitória, ES, Brazil.
authors.forename: Patrícia Lofêgo
authors.initials: PL
authors.lastname: Gonçalves
authors.affiliation: Hospital Universitário Cassiano Antonio de Morais, Universidade Federal do Espírito Santo, Vitória, ES, Brazil.
authors.forename: Maria da Penha
authors.initials: Mda P
authors.lastname: Zago-Gomes
authors.affiliation: Hospital Universitário Cassiano Antonio de Morais, Universidade Federal do Espírito Santo, Vitória, ES, Brazil.
authors.forename: Carlos Sandoval
authors.initials: CS
authors.lastname: Gonçalves
authors.affiliation: Núcleo de Doenças Infecciosas, Centro de Ciências da Saúde, Universidade Federal do Espírito Santo, Vitória, ES, Brazil.
authors.forename: Fausto Edmundo Lima
authors.initials: FE
authors.lastname: Pereira
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil / Q000453:epidemiology; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology* / Q000821:virology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006509:Hepatitis B / Q000150:complications / Q000453:epidemiology*; D006526:Hepatitis C / Q000150:complications / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008113:Liver Neoplasms / Q000453:epidemiology* / Q000821:virology; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D017678:Sex Distribution; D055815:Young Adult