title: Hepatocellular carcinoma: trends of incidence and survival in Europe and the United States at the end of the 20th century.
abstract: OBJECTIVE
  There is large geographic variation in incidence levels and time trends of hepatocellular carcinoma. We compared population-based liver cancer incidence and survival in European and U.S. populations in order to elucidate geographic differences and time trends for these variables.
  
  
  METHODS
  Since comparisons based on cancer registry data are problematic because of variations in liver cancer definition and coding, we considered a subset of cases likely to be mainly hepatocellular carcinoma, suitable for international comparison. Incidence and 5-yr relative survival were calculated from cases diagnosed in five European regions (30,423 cases) and the United States (6,976 cases) in 1982-1994.
  
  
  RESULTS
  Age-standardized incidence was highest in southern Europe (12/100,000 in men and 3/100,000 in women in 1992-94) and lowest in northern Europe, where incidence was similar to that of the United States (3/100,000 in men, <1/100,000 in women). Over the study period, incidence remained stable in the United States and most of Europe, except for a notable increase in southern Europe. Five-year relative survival was <10% in Europe, ranging from 8% (southern Europe) to 5% (eastern Europe), and 6% in the United States. Survival increased slightly with time, mainly in southern Europe and was unaffected by sex, but was better in younger patients.
  
  
  CONCLUSIONS
  Increasing incidence in southern Europe is probably related to hepatitis B and C infection and increasing alcohol intake, while improving survival may be due to greater surveillance for cirrhosis. The survival gap between clinical and population-based series suggests management is better in centers of excellence.
authors.affiliation: National Centre for Epidemiology, Surveillance and Health Promotion, Department of Cancer Epidemiology, Istituto Superiore di Sanità, Rome, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Capocaccia
authors.forename: Milena
authors.initials: M
authors.lastname: Sant
authors.forename: Franco
authors.initials: F
authors.lastname: Berrino
authors.forename: Arianna
authors.initials: A
authors.lastname: Simonetti
authors.forename: Valentina
authors.initials: V
authors.lastname: Santi
authors.forename: Franco
authors.initials: F
authors.lastname: Trevisani
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology* / Q000401:mortality; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000453:epidemiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015996:Survival Rate; D014481:United States / Q000453:epidemiology