Brief Article
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World J Hepatol. Jan 27, 2011; 3(1): 24-30
Published online Jan 27, 2011. doi: 10.4254/wjh.v3.i1.24
First multicenter study for risk factors for hepatocellular carcinoma development in North Africa
Olfa Bahri, Sayeh Ezzikouri, Nissaf Ben Alaya-Bouafif, Fella Iguer, Abdallah Essaid El Feydi, Hafedh Mestiri, Moustapha Benazzouz, Tahar Khalfallah, Rajaa Afifi, Latifa Elkihal, Salah Berkane, Agnes Marchio, Nabil Debzi, Anne Dejean, Pascal Pineau, Hinda Triki, Soumaya Benjelloun
Olfa Bahri, Hinda Triki, Laboratory of Clinical Virology, Institut Pasteur of Tunis, Tunis, BP 1002, Tunisia
Sayeh Ezzikouri, Soumaya Benjelloun, Laboratory of Viral Hepatitis, Institut Pasteur of Casablanca, Casablanca 20100, Morocco
Nissaf Ben Alaya-Bouafif, Laboratory of Epidemiology, Institut Pasteur of Tunis, BP 1002, Tunis, Tunisia
Fella Iguer, Laboratory of Viral Hepatitis, Institut Pasteur of Algiers, El Hamma, Algiers 16108, Algeria
Abdallah Essaid El Feydi, Moustapha Benazzouz, Rajaa Afifi, Latifa Elkihal, Department of Medicine C, Ibn-Sina University Hospital, Rabat 10000, Morocco
Hafedh Mestiri, Tahar Khalfallah, Department of General Surgery, Mongi Slim Hospital, La Marsa 2070, Tunisia
Salah Berkane, Department of Gastroenterology Bologhine University Hospital, Bologhine 16090, Algiers, Algeria
Nabil Debzi, Department of Gastroenterology, Mustapha University Hospital, Algiers 16000, Algeria
Agnes Marchio, Anne Dejean, Pascal Pineau, Nuclear Organization and Oncogenesis Unit, INSERM U993, Institut Pasteur of Paris, Paris 75015, France
Author contributions: Bahri O and Benjelloun S contributed equally to this work; they designed the study and provided financial support; with Pineau P they performed the majority of experiments with Ezzikouri S; Alaya-Bouafif NB performed statistical analysis; Iguer F, El Feydi AE, Mestiri H, Benazzouz M, Khalfallah T, Afifi R, Elkihal L, Berkane S and Debzi N provided the collection of all the human material; Bahri O wrote the manuscript; and Benjelloun S, Pineau P, Marchio A, Dejean A and Triki H were involved in editing the manuscript.
Supported by the “Direction des Programmes Transversaux de Recherches of the Institut Pasteur of Paris (PTR 130)” and the “Tunisian Secretariat for Scientific Research and Technology SERST for Tunisian part of the study (LR: Hépatites et maladies virales épidémiques)”
Correspondence to: Olfa Bahri, MD, Associate Professor, Laboratory of Clinical Virology, Institut Pasteur of Tunis, 13, Place Pasteur, Le Belvédère, BP 74, Tunis 1002, Tunisia. olfa.bahri@pasteur.rns.tn
Telephone: +216-71-843755 Fax: +216-71-791833
Received: October 11, 2010
Revised: December 8, 2010
Accepted: December 15, 2010
Published online: January 27, 2011
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.

Keywords: Hepatocellular carcinoma; Hepatitis B virus; Hepatitis C virus; Non-insulin-dependent diabetes mellitus; North Africa