S. Hoyos1,2,3 1Hepatobiliary and Pancreatic Unit Hospital Pablo Tobón Uribe (HPTU) 2Liver Transplant Program HPTU – Universidad de Antioquia (UdeA) 3Gastrohepatology group UdeA – Epidemiology group Universidad CES
Introduction:
Hepatocellular carcinoma (HCC) is a malignant tumor that usually emerges in cirrhotic patients, mostly associated with chronic alcohol intake, hepatitis C and hepatitis B. The incidence of HCC is highly variable across the world, depending on the relative presence of the underlying liver diseases at each región. (1,2). Is highly prevalent in the east, especially in China, but in Latin America (LA) there is a lack of information about it that is worrisome.
The problem of poor data is attributable to the limited resources that are available to treat costly cancer-related detection and treatment. If the detection of HCC is problematic in more affluent countries (3), what is the possibility of even higher levels of under-estimation in poorer countries because of a combination of data problems, as well as a lack of screening facilities.
The underestimation of HCC is indicated as an underestimation factor that is applied to the current Globocan 2012 country level incidence rates. It is suggests that at least 120,722 cases of HCC may have been missed in 2012 which translates into a revised global incidence of 12.0 versus an observed 10.1 per 100,000. In total, 78 countries appeared to have a significantly underestimated HCC incidence. The underestimation factor (see Fig. 1) for the top 15 countries ranged between a maximum of 9.2 (Cameroon) and 3.5 (Peru). The adjusted country level incidence highlights the widespread increase in HCC in Asia, Africa and South America (4).
Fig. 1. Countries with a significant underestimation of HCC based on the model prediction, 2012
A search in pubmed, medline, scielo, and google academic was done to find articles about HCC in different regions of LA, the terms: “liver cáncer”, “hepatocellular carcinoma”, “liver tumors” and the name of the LA countries were used with the boolean connector AND. Finally, the results from a large multicenter Latin American study of Liver transplant in HCC are presented
In Latin America, some retrospective studies have been performed, basically looking for the different etiologies of HCC, not the prevalence.
In a prospective, multicenter, international study, the etiology of hepatocellular carcinoma in Latin America was presented, 240 patients with HCC were uploaded in a database from different Latin American countries (5). 174 were male (72.5%), 66 were female (27.5%). Median age was 64 years old, interquartile range 57-72, minimal 19, maximal 92 years old. In 205 out of 240 (85.4%) cases, patients had underlying cirrhosis. The main etiology of liver disease were: HCV (30.8%), Alcohol (20.4%), Cryptogenic (14.6%) and HBV (10.8%).
A multicenter Latin American cohort study was done to find the rates of recurrence of hepatocellular carcinoma after liver transplantation (6). A total of 2018 adult patients were consecutively transplanted during the study period in the 15 LT centers in Latin America. From this cohort, 327 of 422 patients with HCC were included in the final analysis, mean age was 57 ± 8 years, 81.7% were men, the most frequent etiology of liver disease was chronic hepatitis B virus infection in 27.8% followed by hepatitis C in 27.2% and alcohol in 17.7%.
In conclusion, although HCC is not still a big problem in Latin America, the inappropriate cancer registries in this countries, makes that the current data are not accurate enough to make an ideal health policies for cancer registry, control and treatment that the patients deserve
References:
1. Sherman M. Hepatocellular carcinoma: epidemiology, risk factors, and screening. Semin Liv Dis 2005; 25: 143-54.
2. Bosch FX, Ribes J, Díaz M, Cléries R. Primary liver cancer: worldwide incidence and trends. Gastroenterology 2004; 127: S5-S16.
3. di Bisceglie AM. Issues in screening and surveillance for hepatocellular carci- noma. Gastroenterology 2004;127:S104–7.
4. K. Sartorius, B. Sartorius, C. Aldous, P.S. Govender T.E. Madiba. Global and country underestimation of hepatocellular carcinoma (HCC) in 2012 and its implications. Cancer Epidemiology 39 (2015) 284–290.
5. Fassio E, Díaz S, Santa C, Reig ME, Martínez Y, Alves de Mattos A, et al. Etiology Of Hepatocellular Carcinoma In Latin America: A Prospective, Multicenter, International Study Ann Hepatol 2010;9:63-69
6. Piñero F, Tisi M, de Ataide EC, Hoyos S, Marciano S, Varón A, et al. Liver Transplantation for Hepatocellular carcinoma: Validation of the French model in a multicenter Latin American cohort. In Press.
