Francesca Garuti1, Andrea Neri1, Francesca Avanzato1, Annagiulia Gramenzi1, Davide Rampoldi1, Paola Rucci2, Fabio Farinati3, Edoardo G Giannini4, Fabio Piscaglia5, Gian Ludovico Rapaccini6, Maria Di Marco7, Eugenio Caturelli8, Marco Zoli9, Rodolfo Sacco10, Giuseppe Cabibbo11, Fabio Marra12, Andrea Mega13, Filomena Morisco14, Antonio Gasbarrini15, Gianluca Svegliati-Baroni16, Francesco G Foschi17, Gabriele Missale18, Alberto Masotto19, Gerardo Nardone20, Giovanni Raimondo21, Francesco Azzaroli22, Gianpaolo Vidili23, Maurizia R Brunetto24, Franco Trevisani1. 1. Semeiotics Unit, Department of Medical and Surgical Sciences, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy. 2. Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy. 3. Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy. 4. Department of Internal Medicine, Gastroenterology Unit, University of Genova, IRCCS Policlinico San Martino, Genova, Italy. 5. Internal Medicine-Piscaglia Unit, Department of Medical and Surgical Sciences, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy. 6. Gastroenterology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy. 7. Medicine Unit, Bolognini Hospital, Seriate, Italy. 8. Gastroenterology Unit, Belcolle Hospital, Viterbo, Italy. 9. Internal Medicine-Zoli Unit, Department of Medical and Surgical Sciences, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy. 10. Gastroenterology and Digestive Endoscopy Unit, Foggia University Hospital, Foggia, Italy. 11. Department of Health Promotion, Mother & Child Care, Internal Medicine & Medical Specialties, PROMISE, Gastroenterology & Hepatology Unit, University of Palermo, Palermo, Italy. 12. Department of Experimental and Clinical Medicine, Internal Medicine and Hepatology Unit, University of Firenze, Firenze, Italy. 13. Gastroenterology Unit, Bolzano Regional Hospital, Bolzano, Italy. 14. Department of Clinical Medicine and Surgery, Gastroenterology Unit, University of Napoli "Federico II", Napoli, Italy. 15. Internal Medicine and Gastroenterology Unit, Policlinico Gemelli, Università Cattolica del Sacro Cuore, Roma, Italy. 16. Gastroenterology Unit, Polytechnic University of Marche, Ancona, Italy. 17. Department of Internal Medicine, Ospedale per gli Infermi of Faenza, Faenza, Italy. 18. Infectious Diseases and Hepatology Unit, Azienda Ospedaliero-Universitaria of Parma, Parma, Italy. 19. Gastroenterology Unit, Ospedale Sacro Cuore Don Calabria, Negrar, Italy. 20. Department of Clinical Medicine and Surgery, Hepato-Gastroenterology Unit, University of Napoli "Federico II", Napoli, Italy. 21. Department of Clinical and Experimental Medicine, Clinical and Molecular Hepatology Unit, University of Messina, Messina, Italy. 22. Gastroenterology Unit, Department of Surgical and Medical Sciences, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy. 23. Department of Medical, Surgical and Experimental Sciences, Clinica Medica Unit, University of Sassari, Azienda Ospedaliero-Universitaria of Sassari, Sassari, Italy. 24. Hepatology and Liver Physiopathology Laboratory and Internal Medicine, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
Abstract
BACKGROUND AND AIMS: Epidemiology of hepatocellular carcinoma (HCC) is changing in most areas of the world. This study aimed at updating the changing scenario of aetiology, clinical presentation, management and prognosis of HCC in Italy during the last 15 years. METHODS: Retrospective analysis of the Italian Liver Cancer (ITA.LI.CA) database included 6034 HCC patients managed in 23 centres from 2004 to 2018. Patients were divided into three groups according to the date of cancer diagnosis (2004-2008, 2009-2013 and 2014-2018). RESULTS: The main results were: (i) a progressive patient ageing; (ii) a progressive increase of non-viral cases and, particularly, of 'metabolic' and 'metabolic + alcohol' HCCs; (iii) a slightly decline of cases diagnosed under surveillance, but with an incremental use of the semiannual schedule; (iv) a favourable cancer stage migration; (v) an increased use of radiofrequency ablation to the detriment of percutaneous ethanol injection; (vi) improved outcomes of ablative and transarterial treatments; (vii) an improved overall survival (adjusted for the lead time in surveyed patients) in the last calendar period, particularly in viral patients; (viii) a large gap between the number of potential candidates (according to oncologic criteria and age) to liver transplant and that of transplanted patients. CONCLUSIONS: During the last 15 years several aspects of HCC scenario have changed, as well as its management. The improvement in patient survival observed in the last period was likely because of a larger use of thermal ablation with respect to the less effective alcohol injection and to an improved management of intermediate stage patients.
BACKGROUND AND AIMS: Epidemiology of hepatocellular carcinoma (HCC) is changing in most areas of the world. This study aimed at updating the changing scenario of aetiology, clinical presentation, management and prognosis of HCC in Italy during the last 15 years. METHODS: Retrospective analysis of the Italian Liver Cancer (ITA.LI.CA) database included 6034 HCC patients managed in 23 centres from 2004 to 2018. Patients were divided into three groups according to the date of cancer diagnosis (2004-2008, 2009-2013 and 2014-2018). RESULTS: The main results were: (i) a progressive patient ageing; (ii) a progressive increase of non-viral cases and, particularly, of 'metabolic' and 'metabolic + alcohol' HCCs; (iii) a slightly decline of cases diagnosed under surveillance, but with an incremental use of the semiannual schedule; (iv) a favourable cancer stage migration; (v) an increased use of radiofrequency ablation to the detriment of percutaneous ethanol injection; (vi) improved outcomes of ablative and transarterial treatments; (vii) an improved overall survival (adjusted for the lead time in surveyed patients) in the last calendar period, particularly in viral patients; (viii) a large gap between the number of potential candidates (according to oncologic criteria and age) to liver transplant and that of transplanted patients. CONCLUSIONS: During the last 15 years several aspects of HCC scenario have changed, as well as its management. The improvement in patient survival observed in the last period was likely because of a larger use of thermal ablation with respect to the less effective alcohol injection and to an improved management of intermediate stage patients.
Authors: Francesco Paolo Russo; Alberto Zanetto; Elisa Pinto; Sara Battistella; Barbara Penzo; Patrizia Burra; Fabio Farinati Journal: Int J Mol Sci Date: 2022-01-02 Impact factor: 5.923