Clinical and epidemiological aspects of hepatocellular carcinoma in Brazil

ABSTRACT

OBJECTIVES: We performed a national survey to update hepatocellular carcinoma (HCC) epidemiology in Brazil and determined the clinical and epidemiological profiles of patients with HCC in different Brazilian regions. METHODS: Data from 29 centers included 1,405 patients diagnosed with HCC from 2004 to 2009. RESULTS: The median age was 59 (1-92 years old; 78 percent male). At diagnosis, females were older than males (median age: 62 vs. 59 years old respectively; p<0.0001). Ninety-eight percent of the patients had cirrhosis (1279/1308). Hepatitis C virus was the main etiology (54 percent), followed by hepatitis B virus (16 percent) and alcohol (14 percent). In Southeastern and Southern Brazil, hepatitis C virus accounted for over 55 percent of cases. In the Northeast and North, hepatitis C virus accounted for less than 50 percent, and hepatitis B virus accounted for 22-25 percent of cases; hepatitis B was more prevalent in the Northern than in the Southern regions. Some 43 percent, 35 percent, and 22 percent of patients were in early, intermediate, and advanced stages respectively. Initial therapies for HCC included chemoembolization or embolization (36 percent), percutaneous ablation (13 percent), liver resection (7 percent), and sorafenib (1 percent). Liver transplantation was performed in 242 patients (19 percent), but it was the initial therapy for only 56 patients (4 percent). CONCLUSION: The epidemiology, classification, and therapy selection for HCC varied among Brazilian regions. Hepatitis C infection was the most common etiology of liver cirrhosis; chemoembolization was the most common therapy employed. Liver cirrhosis was the main risk factor for HCC development in Brazil.