Authors: Sandoval G. Luis, Gatica Manuel.
Background: Guatemala has the highest incidence and mortality of hepatocellular carcinoma (HCC) in the entire American continent. This liver neoplasm is the 7th cause of cancer in Central America, and the 2nd cause of incidence and cancer mortality in Guatemala. There are many risk factors already identified, in the indisputable first place is cirrhosis, then hepatitis B virus (HBV), hepatitis C virus (HCV), alcoholism, nonalcoholic fatty liver disease (NAFLD), etc. Only about 10% of HCCs develop in non-cirrhotic livers. In every day medical practice, we have seen an increase in non-cirrhosis HCC, with no other traditional risk factors. It woke up our curiosity and interest to characterize our hepatic cancer.
Methods: Observational, retrospective and analytic study. All HCCs attended at Instituto Guatemalteco de Seguridad Social (IGSS) in 2015 – 2016 were analyzed, researching for epidemiological data, focusing in differences between cirrhotic vs. non-cirrhotic patients. Statistical analysis was performed with PSPP 2007. Categorical variables were presented with frequency and percentages, and analyzed by chi squared of homogeneity. Normality was tested with Kolmogorov-Smirnov. Numerical data were evaluated with t-student of independent samples. At relational level a bivariate study was made, then elevated to multivariate level.
Result: Total of 53 HCC cases were found, 15 cirrhotic and 38 non-cirrhotic (71.69%). Comparing both groups, there is no statistical difference between age, body mass index (BMI), sex, family history of cancer, alcoholism, tobacco, diabetes mellitus, obesity, HBV, HCV, alpha-fetoprotein (AFP), mass diameter, nor treatment (surgery, transarterial chemoembolization (TACE), radiofrequency ablation and sorafenib). There is difference in jaundice, ascites and encephalopathy, possibly due the same cirrhosis.
Conclusions: HCC in our medical center occurs in apparently healthy livers, contrasting global epidemiology. Staring with this new revealing knowledge we must analyze our medical approach to diagnose and manage HCC in Guatemala, and look for our nontraditional risk factors.View/Download pdf