Risk Factors for Hepatocellular Carcinoma in Transylvania, Romania. A Case Control Study*

Olimpia Chira1, Lucia Jebeleanu2, Claudia Hagiu2, Cristina Ruet3, Zeno Spârchez3, Iuliana Dumitra1
1) 3rd Medical Clinic. 2) Institute of Public Health. 3) University of Medicine & Pharmacy, Cluj-Napoca


There are few data about the prevalence of risk factors for hepatocellular carcinoma (HCC) in our country. We performed a case control study to evaluate the role of HBV and HCV infections, alcohol intake and smoking habits in the development of HCC in our geographical area. A total of 50 newly diagnosed HCC cases admitted to the 3rd Medical Clinic were compared with 100 subjects, sex, age and hospital matched, admitted in the same period for nonhepatic diseases. Serum samples from patients and controls were tested for HBsAg and anti-HCV antibodies. Alcohol intake and smoking habits were recorded by means of a questionnaire.
The majority (72%) of HCC developed on underlying cirrhosis. Among the HCC patients anti-HCV antibodies were found in 34 (68%) and HBsAg was positive in 8 (16%). Among the controls 10% were positive for anti-HCV antibodies and 5% for HBsAg. The difference was highly significant for anti HCV (p= 0.001) having a weak signification for HBsAg positivity ( p= 0.051). History of heavy alcohol intake (>80 g/day for at least 5 years) was found among 56% of cases and 40% of controls. Smoking habits were present in 20% of cases and 38% of controls. The relative risks (odds ratio) for anti-HCV antibodies, HBsAg positivity and heavy alcohol intake were 19.13 (95% CI=7.31-51.51), 3.62 (95% CI=0.99-13.68), and 1.9 (95% CI=0.91-4.02) respectively.
The association between viral markers and heavy alcohol intake was found in 44% of HCC patients. The risk of hepatocellular carcinoma increased from 13.9 to 40 andfrom 2.2 to 8.47 in alcoholic patients anti-HCV positive, HBsAg positive respectively, compared to patients with mild alcohol intake.
Through the computation of population attributable risk, it was found that 47% of HCC could be attributed to HCV infection but only 13.5% to HBsAg positivity. These data provide evidence that HCV infection plays a major role in the development of HCC in Transylvania, Romania.