title: Hepatocellular carcinoma: ten years experience among veterans in Puerto Rico.
abstract: OBJECTIVE
  The aim of our study is to determine the characteristics of hepatocellular carcinoma (HCC) as well as risk factors, demographics, survival rates and the use of diagnostic and therapeutic modalities among veteran patients in Puerto Rico.
  
  
  METHODS
  A retrospective study of 114 patients with Hispanic background and biopsy-proven HCC diagnosed at the VA Caribbean Healthcare System from 1992 to 2002 was performed. Demographics data, Child-Turcotte-Pugh (CTP) score, presence of cirrhosis, viral serology, alcohol and/or other liver diseases history, diagnostic modalities, lesion size, therapy, and overall survival were examined.
  
  
  RESULTS
  The mean age was 66.6 years old. 82% had known underlying cirrhosis. 60% had alcoholic liver disease (ALD), 33% positive serology for hepatitis C (HCV) and 21% both. 5.3% had chronic hepatitis B virus (HBV) infection. Additional causes were not present. CTP classification was: A (42%), B (44%) and C (14%). Abdominal CT scan demonstrated most of the lesions, while ultrasound only 57%. Alfa-fetoprotein was diagnostic in 32%. Mean survival was 10.3 months, better for those with CTP score A. Only 42% of the patients received any kind of therapy.
  
  
  CONCLUSIONS
  ALD is the principal underlying liver disease in our HCC patients, closely followed by chronic HCV infection. Less than half of our patients received treatment mainly due to advanced disease for which the over survival was less than a year. HCC continues to be a dreadful disease with poor prognosis for which aggressive screening should be considered for all patients with cirrhosis and advanced liver disease regardless of the cause.
authors.affiliation: Gastroenterology Department, VA Caribbean Healthcare System, San Juan, Puerto Rico 00921-3201.
authors.forename: Luis J
authors.initials: LJ
authors.lastname: López-García
authors.forename: Doris H
authors.initials: DH
authors.lastname: Toro
authors.forename: Héctor
authors.initials: H
authors.lastname: Mayol
authors.forename: Jaime
authors.initials: J
authors.lastname: Martínez-Souss
authors.forename: María I
authors.initials: MI
authors.lastname: Dueño
authors.forename: Federico
authors.initials: F
authors.lastname: Rodríguez-Pérez
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D008297:Male; D011647:Puerto Rico; D012189:Retrospective Studies; D014728:Veterans