title: Risk factors for hepatocellular carcinoma in Caucasian patients with non-viral cirrhosis: the importance of prior obesity.
abstract: OBJECTIVE
  In patients with cirrhosis, the risk of hepatocellular carcinoma (HCC) depends upon age, gender and the etiology of liver disease. Few studies are available in Caucasian patients with alcoholic or metabolic cirrhosis without viral hepatitis.
  
  
  METHODS
  Cross-sectional clinical data from 905 HCV- and HBV-negative Caucasian patients with alcoholic or metabolic cirrhosis were prospectively collected in four French centres. The risk factors for HCC were identified by logistic regression analysis in the whole population and in a nested case-control study.
  
  
  RESULTS
  The etiology of cirrhosis was alcoholic (48%), metabolic (7%) or mixed (45%). Patients were predominantly male (80%), mean age 62 years old and 31% had HCC. Mean body mass index (BMI) was 27 ± 5 and 30% were obese at inclusion. The maximum BMI reached throughout life was 31 ± 6 and 63% had been obese. Ninety percent of the population had daily alcohol consumption, 73% were smokers. Hepatocellular carcinoma was independently related to male gender (P < 0.0001), older age (P < 0.0001), past obesity (P = 0.007), diabetes (P = 0.037), abnormal levels of transaminases (P < 0.0001) and tobacco consumption (P = 0.007). The case-control study (200 HCC cases matched with 400 non-HCC cases for gender, age and Child-Pugh score) confirmed past obesity, tobacco and abnormal levels of transaminases.
  
  
  CONCLUSIONS
  Beside diabetes, male gender and age, a past history of obesity, but not an existing overweight, as well as exposure to tobacco and elevated transaminases were three risk factors which could improve the strategy for HCC screening in Caucasian cirrhotic patients without hepatitis B or C.
authors.affiliation: Institut des Maladies de l'Appareil Digestif, Hôtel-Dieu, Nantes, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Archambeaud
authors.affiliation: Institut des Maladies de l'Appareil Digestif, Hôtel-Dieu, Nantes, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Auble
authors.affiliation: Service d'Hépatologie, Hôpital Jean Verdier, Bondy, and INSERM U674, Université Paris 5, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Nahon
authors.affiliation: Cellule de Promotion à la Recherche Clinique, Hôtel-Dieu, Nantes, France.
authors.forename: Lucie
authors.initials: L
authors.lastname: Planche
authors.affiliation: Centre Hépato-Biliaire and INSERM 785, Hôpital Paul Brousse, Villejuif, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Fallot
authors.affiliation: Hôpital de la Roche/Yon, Roche/Yon, France.
authors.forename: Roger
authors.initials: R
authors.lastname: Faroux
authors.affiliation: Institut des Maladies de l'Appareil Digestif, Hôtel-Dieu, Nantes, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Gournay
authors.affiliation: Centre Hépato-Biliaire and INSERM 785, Hôpital Paul Brousse, Villejuif, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Samuel
authors.affiliation: Laboratoire de Génétique, Hôtel-Dieu, Nantes, France.
authors.forename: Sebastien
authors.identifier: http://orcid.org/0000-0001-5497-0465
authors.initials: S
authors.lastname: Kury
authors.affiliation: Service d'hépatologie, Hôpital Henri Mondor, Créteil, France.
authors.forename: Cyrille
authors.initials: C
authors.lastname: Féray
mesh_terms: D000367:Age Factors; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects / Q000208:ethnology; D015992:Body Mass Index; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000208:ethnology*; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000208:ethnology; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008019:Life Style / Q000208:ethnology; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000208:ethnology*; D008104:Liver Cirrhosis, Alcoholic / Q000208:ethnology; D008113:Liver Neoplasms / Q000175:diagnosis / Q000208:ethnology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000175:diagnosis / Q000208:ethnology*; D016017:Odds Ratio; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects / Q000208:ethnology; D044465:White People
keywords: Caucasian; cirrhosis; hepatocellular carcinoma; obesity