[Current etiological problems, in France, related to primary liver cancer in cirrhosis (personal observation of 130 cases)].

The etiological problems concerning, in France, hepatocellular carcinoma (H C C) developed on liver cirrhosis, are studied in this work through 130 personal cases followed up during the last decade. These 130 cases of H C C are divided in five groups according to apparent etiology: alcoholic (63%), B virus (15.3%), cryptogenetic (11,5%), hemochromatic (7.6%), autoimmune (2.3%). A review of these cases according to recent publications shows an evidence underestimated for years: we mean the important role played in France by H B V (and probably H C V) not only in chronic cirrhotic hepatitis, but even more in cancerization of cirrhosis in general whatever is the apparent etiology. This role, unsuspected when biological investigations are limited to serological markers of H B V, is demonstrated by implementing more sophisticated+ technics (molecular hybridization+ and gene amplification). But it is very unlikely that this role is exclusive++ and one must recognize that viral "focalization" of recent publications has a tendency to hide other causes of H C C and primarily the toxicological etiology in a wide sense. This etiology is in fact indubitable, already in tropical areas, where the role of mycotoxins and particularly of aflatoxin B l is very well demonstrated, even in areas of very high incidence of H B V. In low incidence areas, such as France, the specific carcinogenic role of alcohol cannot be excluded, neither the role of numerous experimental hepato-carcinogen, very much studied 15 years ago and may be incorrectly forgotten in our days. If the accidents of research lead to privilege temporarily one or the other factor, one must not forget that the genesis of H C C is most probably multifactorial, as for the majority of human cancers.