title: Hepatocellular carcinoma in a low-incidence region. Surgical perspectives.
abstract: OBJECTIVE
  To study the characteristics and outcome of patients with hepatocellular carcinoma in a low-incidence region.
  
  
  METHODS
  98 patients with hepatocellular carcinoma who had been referred to the Surgical Department, National Hospital, Oslo, between 1981 and 1999 were studied retrospectively. Tumour size, prevalence of cirrhosis, serum alpha-fetoprotein concentration, rate of resection, type of resection and survival were analysed.
  
  
  RESULTS
  19% (19/98) of the patients had cirrhosis of varying aetiology. Median tumour size was 10 cm. alpha-Fetoprotein was normal in 46% of the patients. Hepatic resection was performed in 30 (31%) patients and 77% of the resections were major (more than 2 segments). Abdominal exploration was done in 33 patients and liver transplantation in 6 patients. No surgical intervention was made in 31 patients. Five-year actuarial survival in resected patients was 24%. Median survival of non-resected patients was 3.3 months.
  
  
  CONCLUSIONS
  The patient characteristics in this study differ from patient cohorts with hepatocellular carcinoma in other geographical areas. The main differences are large tumour size, low prevalence of the disease, and diverse aetiology of cirrhosis.
authors.affiliation: Surgical Department, National Hospital, Oslo, Norway. tom.mala@Rikshospitalet.no
authors.forename: Tom
authors.initials: T
authors.lastname: Mala
authors.forename: Øystein
authors.initials: Ø
authors.lastname: Mathisen
authors.forename: Anstein
authors.initials: A
authors.lastname: Bergan
authors.forename: Odd
authors.initials: O
authors.lastname: Søreide
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001707:Biopsy, Needle; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery*; D016022:Case-Control Studies; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D015994:Incidence; D008113:Liver Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009664:Norway / Q000453:epidemiology; D011379:Prognosis; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome