Relative incidence of primary liver cancer in cirrhosis in Austria. Etiological considerations.

The incidence of primary liver cancer (PLC) was assessed in 652 patients (429 male, 223 female) with liver cirrhosis. By the end of the study 416 (64%) of all patients had died. The autopsy rate was 65%. PLC developed in 73 patients. Histologically, 67 cases were classified as hepatocellular (HCC), one as mixed hepatocellular-cholangiocellular and five as cholangiocellular carcinoma. In 30 cases, HCC was confirmed within a year of diagnosis of cirrhosis, and in the remaining 37 cases HCC developed 2-13 years later. At autopsy, the frequency of HCC was almost twice as high in males (27%) as in females (15%) (p less than 0.025). This difference occurred in alcoholic and posthepatitic cirrhosis but not in cryptogenetic cirrhosis. HBsAg was detected in 19.0% of male and 9.2% of female patients (p less than 0.01). Comparison of patients with and without HCC revealed no significant differences in the prevalence of HBsAg. These data indicate that HCC is common in Austrian patients with cirrhosis, representing 60% of all malignant tumors in this group. In view of the high HBsAg carrier rate and the prevalence of chronic alcoholism in patients with cirrhosis, it is suggested that the two factors together lead to an increased risk of cirrhosis followed by an increased incidence of HCC.