Abstract
Aims: To evaluate epidemiology, clinical features and survival of HCV-related HCC in a wide time range in Italy. Methods: Multicenter retrospective study including 2750 patients prospectively recruited by the ITA.LI.CA group (11 units). The patients were classified in three groups (GA, HCV associated or not with other etiologies, GB, pure HCV, and GC, alternative etiologies) and sub-grouped in 5 time cohorts, of 5 years (1986–90, 91–95, 96– 2000, 2001–2005) but for the last one (2006–2008). The following features were analyzed: age, gender, Child–Pugh status, diagnosis for surveillance, stage, thrombosis and metastases, treatment and survival (Kaplan–Meier, Log-Rank). Results: 1793 patients were included in GA, 1440 in GB, 957 in GC. Both the number of GA and GB patients reached a peak in the 1996–2000 to then gradually drop, lowest values being observed in the last three years (p = 0.0001 GA, 0.01 GB). Mean age at diagnosis progressively increased in GA (p < 0.0001) and GB (p < 0.001) but not in GC. Same was true for the percentage of cases diagnosed under surveillance (GA p=0.019, GB p=0.0038) and for the share of patients in Child–Pugh A stage (GA p=0.01, GB p=0.0077). Mean tumor size decreased in all subgroups, tumor stage improved significantly only in GB. Median survival significantly increased in all groups but more significantly so in GA and GB, with a significant difference between GA and GB vs GC in the last 3 time periods (p = 0.02). Conclusions: The incidence of HCC in HCV-related liver disease is decreasing in Italy since 2001. HCV-related HCC patients are older, more frequently diagnosed under surveillance, more frequently characterized by conserved liver function and smaller tumors, with an earlier tumor stage when HCV is the only etiologic factor. Finally their survival dramatically improved in the last 15 years, to a larger extent than in patients with different etiology. We therefore expect a further drop in incidence and mortality for the disease in the years to come.
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