[Primary hepatocarcinoma. Epidemiologic case-control study in the province of Bergamo].Minerva Med. 1986 Mar 10; 77(9-10):297-306.MM
This is the first epidemiological study of Hepatocellular Carcinoma (HCC) in the province of Bergamo, an area well-known to have a high incidence of HBsAg (9.1%) and chronic alcoholic liver disease. 72 cases of HCC (60 male, 12 female) al from the province of Bergamo and encountered in 1980-84 were subjected to an epidemiological case-control study. Analysis of the results confirmed the role of certain known Risk Factors (RF) with a prevalence of male sex (83.3%), age (mean age 63), association with live cirrhosis (79.2%) and HBsAg+ (31.9%). Such findings are in line with the Italian average found in previous studies. No difference between the sexes was found in these RF except for alcoholic abuse which was significantly higher in the males (53.3%, p less than 0.05). The case-control correlation analysis revealed no difference in the prevalence of alcohol addiction and previous HBV infection (HBV-Ab+) between the HCC (with or without cirrhosis) and the various control groups (Group A: patients with no liver pathology. Group B: patients with cirrhosis of the liver). HBsAg+ was significantly higher among HCC patients without cirrhosis (46.6%, p less than 0.001), but there was no significant difference between HCC + cirrhosis and cirrhosis alone (88%). The difference between "expected" and "observed" HCC-HBsAg+ was highly significant (p less than 0.001). The overall Relative Risk (RR) of HCC for the RF-HBsAg+ was 4.6. When divided into subgroups this gave: RR = 1 for patients with cirrhosis of the liver. RR = 11.5 for patients with no liver pathology. These data confirm the importance of current HBV infection (HBsAg+), in the province, though the presence or absence of cirrhosis probably influences its significance. The approximate incidence of HCC is 9.7%/100,000/year. Considering the limitations of data on a small monocentric study in a limited area (USSL no. 30) the figure is probably underestimated and the real incidence probably higher.