Epidemiology and outcome of hepatocellular carcinoma in Lombardy

Abstract

Background and aims: Information on the impact of therapeutic strategies of hepatocellular carcinoma is still incomplete due to the lack of surveys involving primary-care centres.

Patients and methods: The Gruppo Epatologico Lombardo (GEL) carried out a study on 361 incident hepatocellular carcinoma observed from January to December 1998 in 22 hospitals in Lombardy. The clinical, pathological and therapeutic data were collected from all patients; 5-year survival and factors related to outcome were analysed.

Results: Two hundred and ninety-seven patients were male (M/F: 4.6/1, mean age 66); 61% were HCV-pos, 15% HBV-pos, 17% alcoholic. Cirrhosis was present in 333 (92%) and was classified as Child-A in 197 (59%), Child-B in 85 (26%) and Child-C in 51 (15%) cases. Hepatocellular carcinoma was multifocal/diffuse (more than three nodules) in 91 (25%), less than three nodules in 86 (24%) and monofocal in 184 (51%) (</=3cm in 146). As to the therapy: 145 hepatocellular carcinomas (40%) were untreated, 78 (22%) underwent percutaneous ethanol injection/radiofrequency ablation, 75 (20%) transarterial chemoembolization, 32 (9%) liver resection and 3 (0.8%) ortothopic liver transplantation (OLT). Survivals at 1, 3 and 5 years were 75%, 27% and 13%, respectively. Child-Pugh score, small size of the tumour and treatment, regardless of the type, were independent predictors of better prognosis.

Conclusion: This prospective, region-wide, cohort study showed that the characteristics of hepatocellular carcinoma in Lombardy (1998) do not differ from those reported in previous Italian surveys. Although most hepatocellular carcinomas were discovered at a relatively early stage, a large part remained untreated and the overall prognosis was poor. Efforts are warranted to implement screening-surveillance programmes and the impact of therapeutic strategies.