Primary liver cancer in non-cirrhotic liver. Epidemiological study based on autopsies performed in Trieste, Itly and Kurume, Japan

This study, aimed at elucidating the epidemiological features of primary liver carcinoma developing in non-cirrhotic livers, waqs based on 25103 autpsies performed between 1975 and 1984 in Trieste, Italy. These autopsies correspond to approximately 70% of all deaths that occured in this area. Various factors allegedly related to carcinomas were analysed in reference to our previous sutdy on cirrhotic livers and in comparison with 5603 autopsies in Kurume, Japan. There were 28 cases of hepatocellular carcinoma (HCC) , 16 of cholangiocellular carcinoma (CCC) not assocaited with cirrhosis in Triete, and 48 HCC and 19 CCC in Kurume. On the basis of our findings, it was concluded that cirrhosis, regardless of its cause, is the main pathogenetic factor in HCC; it is responsible for a much higher frequency (14.2:1) than in non-cirrhotic livers, as well as for early occurence of tumours (an average of 6 years earlier in cirrhotic liver) in Trieste. Patients in Trieste were older than those in Japan, and the prequency of HCC among alla autopsies wa much greater in the latter. By contrast, ihe influence of cirrhosis on cholangiocellular carrcinoma (CCC) was negligible, as such association appeared purely coincicental or absent. The incidence of CCC among autopsies was grater in Japan. Our data on CCC were not sufficietn to demonstrate any clear aetiopathogenetic association between this tumour and alchol abuse and hepatitis B virus (HBV) infection, exept for a possible aetiological rol of gallstones. The frequenciy of CCC relative to HCVCwas greater in Trieste than in Japan; the incidence of HCC was much less in Trieste, whereas CCC was maore frequent in Japan.