The registry of digestive tract tumours established for the department of Cote d'Or (France) was used to study the incidence and some of the characteristics of primary liver cancer (PLC) in this area. The annual age-standardized incidence rate was 7.6/100,000 for males, and 1.8/100,000 for females. As compared to other areas the Cote d'Or is in the intermediate incidence areas. The risk of PLC was higher in urban than in rural areas in men (p less than 0.01). There was no significant variation in PLC incidence over the eight years of the study. Alfafoetoprotein levels over 200 ng/ml were observed in only 48.9% of the cases. Alfafoetoprotein measurement has to be complemented by other investigations in screening of high-risk patients. Liver cirrhosis was present in 70.9% of the cases in which the information was available. The male:female ratio in the non-cirrhotic group was 1.5:1, very different to the 8.8:1 in the cirrhotic group. Cirrhosis was associated with excessive alcohol consumption in 92% of cases. The prevalence of serological markers of hepatitis B virus infection was investigated in 91 patients. Hepatitis Bs-antigen was found in 8.8% and evidence of past or present infection in 28.2%. In view of the prevalence of chronic alcoholism in patients with cirrhosis it is suggested that alcohol leads to an increased risk of cirrhosis followed by an increased incidence of PLC. Further studies are needed to elucidate the eventual role of HBV infection and other suspected environmental factors in the aetiology of PLC.
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