Primitive liver cancers: epidemiology and geographical study in France

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Abstract
Objectives The objectives of this study are, first, to describe the incidence of primary liver cancer (PLC) and, second, to highlight its epidemiological characteristics from a geographical point of view. Methods The nine French administrative areas, which are covered by population-based cancer registries, diagnosed a total of 1100 new cases of PLC (of which 898 occurred in males), between 1997 and 1998; 91.5% of these were identified as hepatocellular carcinoma, and 6.2% corresponded to intrahepatic cholangiocarcinoma. The incidence rates of these new cases were studied as a function of their clinico-pathological features and geographical location. Results The age-adjusted incidence was 9.5 per 100 000 persons amongst males, and 3.1 per 100 000 persons amongst females. The origin of cirrhosis was found to be alcohol consumption (69%), followed by viral contamination, and lastly 4.9% for both. A north–south gradient was found for the age-standardized incidence rates in men (10.1 per 100 000 in the north vs. 6.5 per 100 000 in the south; P=0.029). Amongst men in the north, the most frequent etiological type was cirrhosis (79.8 vs. 72.5%; P=0.0018). The alcoholic origin of cirrhosis was more frequent in the north than in the south (66 vs. 27.5%; P−4). Viral cirrhosis was more frequent in the south than in the north (42.9 vs. 13.6%; P−4). Conclusion In France, excessive alcohol consumption remains the main risk factor for PLC, although the viral etiology of this disease is growing. An opposition was found between the two groups. North-men-alcoholic cirrhosis and south-women-viral cirrhosis.