Características epidemiológicas e fatores de risco do carcinoma hepatocelular.

Abstract

Introduction: Hepatocellular carcinoma (HCC) is the most common primary neoplasm of the liver. It constitutes an important cause of cancer mortality in cirrhotic patients. Objective: To evaluate the epidemiological aspects relating them to the risk factors of HCC in a closed population. Methods: We conducted a retrospective cross-sectional study with chart review of patients treated from November 1998 to May 2011 in the Departments of Liver Transplantation, Gastroenterology and Pathology and the Cancer Institute of the Hospital de Base, São José do Rio Preto. The study was approved by the Ethics and Research. Results: A total of 272 patients with HCC, 229(84.2%) were male and 43 (15.8%) were female. The mean age was 57.1 years (SD 10.9 years) and predominantly caucasian (91.5%). Cirrhosis present in 98.2% with Child-Turcotte-Pugh class B in 104 patients (38.9%). The etiology, the most frequent was infection with hepatitis C virus in 145(55.1%) patients being single cause in 88(33.4%). The results suggest that sex is associated with the principal factors in the etiology of HCC, but age was not associated with disease etiology. In 220 patients, the largest nodule, ranged from 6mm to 260mm in diameter with a mean of 61.4mm (SD 41.5mm). In 145(64.2%) patients revealed the presence of a nodule and 46(20.3%) patients multifocal. It was found that 8(3.6%) only nodules had a diameter smaller than 20mm and 74(33.5%) diameters of between twenty and fifty millimeters. Of the 214 patients classified according to staging, 70(32.7%) were early stage and 97 among more advanced stage and terminal (30.4% and 14.9% respectively). Thirty(11%) patients were incidental findings. Regarding the diagnosis of HCC, 175 patients (68.1%) were diagnosed by an imaging study. The time between diagnosis and initial treatment, a total of 224 patients, 86(38.4%) was started in the first month and 46(20.5%) between 30 and 60 days. The average start of treatment was 70.7 days (SD 86.1 days), specific treatment was conducted in 236(86.8%) patients in which chemoembolization 127(46.7%) and liver transplantation in 72(26.5%), of whom 33(45.8%) received chemoembolization as a "bridge" to transplant. Thirty-four patients (12.5%) received only supportive therapy. Level of α-fetoprotein was measured in 209 patients with 29.2% less than 20 ng/ml and 34.9% at above 400 ng/ml. In patients with thyroid nodules diameter greater than or equal to 10 cm, were 67.8% α-fetoprotein levels greater than 400 ng / ml. In 144 patients, histological analysis showed that in 94 (65.3%) nodules were moderately differentiated. Conclusion: Prevalence of male and involvement in the 5th decade of life. Hepatic cirrhosis present in most patients. Infection with hepatitis C followed by alcoholic liver disease were more common etiologies. Diagnosis was delayed or advanced stages, and dosage levels of α-fetoprotein was not good tool diagnostic. Treatment of HCC showed a predominance of non-curative therapies due to late diagnosis.