First multicenter study for risk factors for hepatocellular carcinoma development in North Africa.

Olfa Bahri 1, * Sayeh Ezzikouri 2 Nissaf Ben Alaya-Bouafif 1 Fella Iguer 3 Abdallah Essaid El Feydi 4 Hafedh Mestiri 5 Moustapha Benazzouz 4 Tahar Khalfallah 5 Rajaa Afifi 4 Latifa Elkihal 4 Salah Berkane 6 Agnes Marchio 7 Nabil Debzi 8 Anne Dejean 7 Pascal Pineau 9 Hinda Triki 1 Soumaya Benjelloun 2
* Corresponding author
1 Institut Pasteur de Tunis
2 VHL - Viral Hepatitis Laboratory
3 Institut Pasteur d'Algérie
4 Department of Medicine C
5 Centre Hospitalier Universitaire Mongi Slim [La Marsa]
6 Department of Gastroenterology Bologhine
7 Organisation Nucléaire et Oncogenèse
8 Department of Gastroenterology
9 Organisation Nucléaire et Oncogenèse
Abstract : AIM: To assess the role of the major risk factors for hepatocellular carcinoma (HCC) development in the western part of North Africa. METHODS: A multicenter case control study was conducted in Tunisia, Morocco and Algeria in collaboration with Pasteur Institutes in these countries. A total of 164 patients with HCC and 250 control subjects without hepatic diseases were included. Prevalences of HBsAg, anti-hepatitis C virus (HCV) and diabetes were assessed. HCV and HBV genotyping were performed for anti-HCV and HBsAg positive patients. RESULTS: The mean age of patients was 62 ± 10 years old for a 1.5 M:F sex ratio. Sixty percent of HCC patients were positive for anti-HCV and 17.9% for HBsAg. Diabetes was detected in 18% of cases. Odd ratio (OR) and 95% confidence intervals (CI) were 32.0 (15.8 - 65.0), 7.2 (3.2 - 16.1) and 8.0 (3.1 - 20.0) for anti-HCV, HBsAg and diabetes respectively. Multivariate analysis indicated that the three studied factors were independent. 1b HCV genotype and D HBV genotype were predominant in HCC patients. HCV was the only risk factor significantly associated with an excess of cirrhosis (90% vs 68% for all other risk factors collectively, P = 0.00168). Excessive alcohol consumption was reliably established for 19 (17.6%) cases among the 108 HCC patients for whom data is available. CONCLUSION: HCV and HBV infections and diabetes are the main determinants of HCC development in North Africa. An active surveillance and secondary prevention programs for patients with chronic hepatitis and nutrition-associated metabolic liver diseases are the most important steps to reduce the risk of HCC in the region.
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PASTEUR | RIIP_TUNIS | RIIP | RIIP_MAROC | RIIP_ALGERIE

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Olfa Bahri, Sayeh Ezzikouri, Nissaf Ben Alaya-Bouafif, Fella Iguer, Abdallah Essaid El Feydi, et al.. First multicenter study for risk factors for hepatocellular carcinoma development in North Africa.. World Journal of Hepatology, 2011, 3 (1), pp.24-30. ⟨10.4254/wjh.v3.i1.24⟩. ⟨pasteur-00859430⟩

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