Multicenter Epidemiologic Study on Hepatocellular Carcinoma in Turkey

  • Can, Alper ;
  • Dogan, Erkan ;
  • Bayoglu, Ibrahim Vedat ;
  • Tatli, Ali Murat ;
  • Besiroglu, Mehmet ;
  • Kocer, Murat ;
  • Dulger, Ahmet Cumhur ;
  • Uyeturk, Ummugul ;
  • Kivrak, Derya ;
  • Orakci, Zuat ;
  • Bal, Oznur ;
  • Kacan, Turgut ;
  • Olmez, Sehmus ;
  • Turan, Nedim ;
  • Ozbay, Mehmet Fatih ;
  • Alacacioglu, Ahmet
  • Published : 2014.03.30


Background: Hepatocellular cancer (HCC) is one of the important health problems in Turkey, being very common and highly lethal. The aim of this study was to determine clinical, demographic features and risk factors. Materials and Methods: Nine hundred and sixth-three patients with HCC from 13 cities in Turkey were included in this study. Results: Only 205 (21%) of the 963 patients were women, with a male:female predominance of 4.8:1 and a median age of 61 years. The etiologic risk factors for HCC were hepatitis B in 555 patients (57.6%), 453 (81%) in men, and 102 (19%) in women, again with male predominance, hepatitis C in 159 (16.5%), (14.9% and 22.4%, with a higher incidence in women), and chronic alcohol abuse (more than ten years) in 137 (14.2%) (16.8% and 4.9%, higher in males). The Child-Pugh score paralleled with advanced disease stage amd also a high level of AFP. Conclusions: According to our findings the viral etiology (hepatitis B and hepatitis C infections) in the Turkish population was the most important factor in HCC development, with alcohol abuse as the third risk factor. The Child-Pugh classification and AFP levels were determined to be important prognostic factors in HCC patients.


Hepatocellular carcinoma;etiologic factors;alpha-fetoprotein;Turkey


  1. Turkey Liver Research Association National Hepatitis Often Study (TURKHEP 2010).
  2. Zidan A, Scheuerlein H, Schule S, et al (2012). Epidemiological pattern of hepatitis B and hepatitis C as etiological agents for hepatocellular carcinoma in Iran and wordwide. Hepat Mon, 12, 14-22.
  3. Wang BE, Ma WM, Sulaiman A, et al (2002). Demographic, clinical, and virological characteristics of hepatocellular carcinoma in Asia: survey of 414 patients from four countries. J Med Virol, 67, 394-400.
  4. Stuart KE, Anand AJ, Jenkins RL (1996). Hepatocellular carcinoma in the United States. Prognostic features, treatment outcome, and survival. Cancer, 77, 2217-22.<2217::AID-CNCR6>3.0.CO;2-M
  5. Su CH, Lin Y, Cai L (2013). enetic factors, viral infection, other factors and liver cancer: an update on current progress. Asian Pac J Cancer Prev, 14, 49053-60.
  6. Yaprak O, Akyildiz M, Dayangac M, et al (2012). AFP level and histologic differentiation predict the survival of patients with liver transplantation for hepatocellular carcinoma. Hepatobiliary Pancreat Dis Int, 11, 256-61.
  7. Uzunalimoglu O, Yurdaydin C, Cetinkaya H, et al (2001). Risk factors for hepatocellular carcinoma in Turkey. Dig Dis Sci, 46, 1022-8.
  8. Xu J, Liu C, Zhou L, et al (2012). Distinctions between clinicopathological factors and prognosis of alphafetoprotein negative and positive hepatocellular carcinoma patients. Asian Pac J Cancer Prev, 13, 559-62.
  9. Yalcin K, Yakut M, Degertekin H, et al (2013). Clinical and epidemiological characteristics of hepatocellular carsinoma cases in East and Southeastern Region of Turkey. Clin J Med, 33, 806-13.
  10. Yeo Y, Gwack J, Kang S, et al (2013). Viral hepatitis and liver cancer in Korea: an epidemiological perspective. Asian Pac J Cancer Prev, 14, 6227-31.
  11. Zhang BH, Yang BH, Tang ZY (2004). Randomized controlled trial of screening for hepatocellular carcinoma. J Cancer Res Clin Oncol, 130, 417-22.
  12. Monto A, Wright TL (2001). The epidemiology and prevention of hepatocellular carcinoma. Semin Oncol, 28, 441-9.
  13. Lim HY, Sohn I, Deng S, et al (2013). Prediction of disease-free survival in hepatocellular carcinoma by gene expression profiling. Ann Surg Oncol, 20, 3747-53.
  14. Markovic S, Gadzijev E, Stabuc B, et al (1998). Treatment options in Western hepatocellular carcinoma: a prospective study of 224 patients. J Hepatol, 29, 650-9.
  15. Marrero CR, Marrero JA (2007). Viral hepatitis and hepatocellular carcinoma. Arch Med Res, 38, 612-20.
  16. Norsa'adah B, Nurhazalini-Zayani CG (2013). Epidemiology and survival of hepatocellular carcinoma in north-east peninsular Malaysia. Asian Pac J Cancer Prev, 14, 6955-9.
  17. Ozer B, Serin E, Yilmaz U, et el (2003). Clinicopathologic features and risk factors for hepatocellular carcinoma: results from a single center in southern Turkey. Turk J Gastroenterol, 14, 85-90.
  18. Purtilo DT, Kersey JH, Hallgren HM, et al (1973). Alphafetoprotein: diagnostic and prognostic use in patients with hepatomas. Am J Clin Pathol, 59, 295-9.
  19. Sakar B, Ustuner Z, Karagol H, et al (2004). Prognostic features and survival of inoperable hepatocellular carcinoma in Turkish patients with cirrhosis. Am J Clin Oncol, 27, 489-93.
  20. Schoniger-Hekele M, Muller C, Kutilek M, et al (2001). Hepatocellular carcinoma in Central Europe: prognostic features and survival. Gut, 48, 103-9.
  21. Stroffolini T, Andreone P, Andriulli A, et al (1998). Characteristics of hepatocellular carcinoma in Italy. J Hepatol, 29, 944-52.
  22. Fong Y, Sun RL, Jarnagin W, et al (1999). An analysis of 412 cases of hepatocellular carcinoma at a Western center. Ann Surg, 229, 790-800.
  23. Bruix J, Sherman M (2005). Menagement of hepatocellular carcinoma. An update. AASLD Practice Guidelines.
  24. Chang HC, Lin YM, Yen AMF, et al (2013). Predictors of longterm survival in hepatocellular carcinomas: a longitudinal follow-up of 108 patients with small tumors. Anticancer Res, 33, 5171-8
  25. Dogan E, Yalcin S, Koca D, et al (2012). Clinicopathological characteristics of hepatocellular carcinoma in Turkey. Asian Pac J Cancer Prev, 13, 2985-90.
  26. Geramizadeh B, Asadi N, Tabei SZ (2012). Cytologic comparison between malignant and regenerative nodules in the background of cirrhosis. Hepat Mon, 12, 448-52
  27. Hassan MM, Hwang LY, Hatten CJ, et al (2002) Risk factors for hepatocellular carcinoma: synergism of alcohol with viral hepatitis and diabetes mellitus. Hepatology, 36, 1206-13.
  28. Kamangar F, Dores GM, Anderson WF (2006). Patterns of cancer incidence, mortality, and prevalence across five continents: defining priorities to reduce cancer disparities in different geographic regions of the world. J Clin Oncol, 24, 2137-50.
  29. Lee FI (1966). Cirrhosis and hepatoma in alcoholics. Gut, 7, 77-85.
  30. Lee CH, Hsieh SY, Lin JL et al (2013). Hepatocellular carcinoma in patients with chronic kidney disease. World J Gastroenterol ,19, 2466-72.
  31. Lehman EM, Wilson ML (2009). Epidemiology of hepatitis viruses among hepatocellular car cinoma cases and healthy people in Egypt: a systematic review and meta-analysis. Int J Cancer, 124, 690-7.
  32. Bosch FX, Ribes J, Borras J (1999). Epidemiology of primary liver cancer. Semin Liver Dis, 19, 271-85.
  33. Alacacioglu A, Somali I, Simsek I, et al (2008). Epidemiology and survival of hepatocellular carcinoma in Turkey: outcome of multicenter study. Jpn J Clin Oncol, 38, 683-8.
  34. Beasley RP, Hwang LY, Lin CC, et al (1981). Hepatocellular carcinoma and hepatitis B virus. A prospective study of 22 707 men in Taiwan. Lancet, 21, 1129-33.
  35. Borzio M, Colloredo G, Pioltelli P, et al (2007). Epidemiology and outcome of hepatocellular carcinoma in Lombardy. Dig Liver Dis, 39, 1011-7.

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