Risk factors for hepatocellular carcinoma in Southern Iran

OBJECTIVE: Hepatocellular carcinoma (HCC) is one of the most common cancers in the world. Its etiology and incidence differ according to geographic area. In the present study, we sought to identify risk factors for HCC among a group of patients with HCC in Southern Iran.

METHODS: During a 5-year period we retrospectively studied the characteristics of 71 HCC patients at Ahwaz Jundishapur University Hospital, Iran from February 1999 to August 2004. Blood samples and questionnaire data obtained from 71 (45 male and 26 female) incident cases of HCC, were pathologically diagnosed. Sera were tested for hepatitis B surface antigen and antibodies to hepatitis B core antigen, anti-hepatitis C virus and serum ferritin, iron and alfa fetoprotein (AFP), by enzyme immunoassays and cuper study.

RESULTS: In 46.5% (33/71) of patients there was a history of chronic liver disease, and in 30 (42%) patients liver cirrhosis was documented. Of the 71 patients, 37 (52.1%) had hepatitis B, 6 (8.5%) had hepatitis C, and 2 (2.8%) had a history of excess alcohol intake. Of the 2 patients with a history of heavy alcohol intake, one had concomitant chronic viral hepatitis infection, and alcohol alone was the etiology of HCC in only one case (1.40%). No etiologic cause was identified in 23 cases (32.4%), there were 2 cases of diabetes mellitus. The value of AFP of >20 ng/ml was found in 29 cases(41%), varying from 24 ng/ml to 364 ng/ml (average 74.6 ng/ml).

CONCLUSION: In Southern Iran, the predominant etiology of HCC was hepatitis B, hepatitis C, but alcohol and metabolic diseases were only found in rare cases. Cryptogenic cases may be found in one fifth of patients hence, the contribution of virus infection, may have been underestimated in this area, which is based on serological testing only.