Epidemiology of Hepatitis B-Associated Hepatocellular Carcinoma in Cameroon

ABSTRACT

Background: Chronic hepatitis B virus (HBV) infection and cirrhosis are major risk factors for the development of hepatocellular carcinoma (HCC). In Cameroon, which is a highly endemic zone for HBV, its epidemiologic characteristics are not known. The aim of our study was to determine the epidemiologic characteristics of hepatitis B-associated HCC in our milieu for a better management of the disease. Methods: Patients suffering from HCC in two hospitals in Yaounde were sampled and screened for HBV, HCV and HDV. Only HBV related HCC were enrolled. Demographic characteristics, presence or not of cirrhosis, excessive alcohol consumption (>80g/day) and smoking were analyzed. Results: A total of 34 cases of HCC were identified. The mean age was 38.5±12.3 years (extremes 18 ­ 74 years); 79.4% (27/34) were males (sex ratio 3.91); 55.9% (19/34) had cirrhosis while 44.1% (15/34) were non cirrhotic. Also, 44.1% (15/34) were smokers and 2.9% (1/34) were alcoholics. The prevalence of HCC was 14.7%, 47.7%, 20.6%, 11.8% and 5.9% amongst those below 30 years, 30­39 years, 40­49 years, 50­59 years and 60 years and above respectively. There was no statistically significant difference between the mean ages of cirrhotic and non cirrhotic patients (38.9±11.3 vs. 38.0±14 years, p=0.08). The majority of patients below 30 years had no cirrhosis at the moment the diagnosis of HCC was made (80% vs. 39.9%, p=0.08). Cirrhosis was more frequent amongst those aged 30­39 years (68.8% vs. 44.4%, p=0.16). There was no other difference between cirrhotic and non cirrhotic patients. Neither alcohol nor smoking had no a synergic effect in the development of HCC. Conclusion: Most patients with hepatitis B-associated HCC in Cameroon are aged below 40 years. Cirrhosis is not always present at diagnosis. The epidemiologic profiles of cirrhotic and non cirrhotic patients are similar. The influence of alcohol and tobacco is negligible. The introduction of HBV vaccine in the extended immunization program in 2005 was thus necessary in our country