Liver morphology in southern african blacks with hepatocellular carcinoma: A study within the urban environment
✍ Scribed by Alan C. Paterson; Michael C. Kew; Allen A. B. Herman; Pieter J. Becker; John Hodkinson; Charles Isaacson
- Publisher
- John Wiley and Sons
- Year
- 1985
- Tongue
- English
- Weight
- 984 KB
- Volume
- 5
- Category
- Article
- ISSN
- 0270-9139
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✦ Synopsis
Hepatocellular carcinoma has a lower prevalence and presents at a later age in urban Blacks than in rural Blacks. These differences have previously been shown not to be attributable to differences in serum hepatitis B virus markers. In the present study, the average age of patients with hepatocellular carcinoma in a developing urban Black population is shown to have risen from 38.9 to 56.5 years (p c 0.0001) over a 20-year interval, while the prevalence of co-existing cirrhosis has declined from 66 to 44% (p < 0.05) and tissue HBsAg positivity has fallen from 44 to 17.7% (p = 0.002). The lower prevalence of tissue HBsAg in the recent patients may be explained by their older age. Macronodular cirrhosis was present in 56% of cases in the earlier period but declined to 18.9% in the later period, with micronodular cirrhosis becoming the dominant nontumor pathology (p = 0.002). Liver damage attributable to the abuse of alcohol is now found in more than half of the cases (48/90) of hepatocellular carcinoma occurring in this population. The remainder show no changes (12 cases) or show macronodular or incomplete septa1 cirrhosis (30 cases), presumed to be of viral origin. The latter cases are more likely to have serum markers of current hepatitis B virus infection than those with evidence of alcohol abuse. We conclude that alcohol is increasing in importance as an etiologic association of hepatocellular carcinoma in urban South African Blacks. At the same time, the prevalence of macronodular cirrhosis (and of cirrhosis as a whole) in urban patients with this tumor has declined. The reason for this decline is not known.
Hepatocellular carcinoma (HCC) has a lower incidence in urban than in rural Black populations in southern Africa (1-3). In addition, the average age of urban Blacks with this tumor has increased steadily over the past 20 years (4) and is now significantly older than that of their rural counterparts (5). Although a large urban Black population now exists in South Africa, the majority of Black patients presenting with HCC in the urban environment still have a rural origin, having migrated to the cities on reaching work-seeking age. Hepatitis B viru: (HBV) infection is endemic in the rural parts of southern Africa, and Black children become infected at a verv early age (6). It is therefore unlikely that the different