Hepatocellular carcinoma in patients with cryptogenic cirrhosis.
OBJECTIVE
Patients with cryptogenic cirrhosis (CC) can develop hepatocellular carcinoma (HCC), although the clinical characteristics of HCC in these patients have not been completely defined. We aimed to characterize the clinical features of patients diagnosed with HCC after CC during a 15-year period (1992-2006).


METHODS
The clinical characteristics of 45 consecutive CC patients with HCC were analyzed, along with modality of diagnosis, tumor stage, treatment, survival, and causes of death. Data were compared with those of 426 consecutive patients with HCC and only hepatitis C virus (HCV) infection, diagnosed during the same period at the Italian Liver Cancer group centers.


RESULTS
HCC patients with CC had similar impairments in liver function as patients with HCV infection (Child-Pugh class A: 53% vs 65%; P = .141). However, the HCC patients with CC had lower aminotransferase levels (P < .001) and higher platelet counts (P < .001). HCC was significantly less likely to be diagnosed during surveillance in CC patients (29% vs 64%; P < .0001). Patients with CC had a significantly greater prevalence of advanced HCC stage, according to Milano criteria (69% vs 41%; P < .0005), larger HCC size (4.9 vs 3.0 cm; P = .0001), lower amenability to any treatment (27% vs 42%; P = .036), and shorter survival times (P = .009, log-rank test) compared with HCV patients. Causes of death were similar in the 2 groups.


CONCLUSIONS
Compared with HCV patients, HCC in CC patients often is diagnosed at an advanced stage, probably owing to lack of surveillance; this leads to limited treatment options and shorter survival times.
Cattedra di Gastroenterologia, Dipartimento di Medicina Interna, Università di Genova, Genova, Italy. egiannini@unige.it
Edoardo Giovanni
EG
Giannini
Elisa
E
Marabotto
Vincenzo
V
Savarino
Franco
F
Trevisani
Maria Anna
MA
di Nolfo
Paolo
P
Del Poggio
Luisa
L
Benvegnù
Fabio
F
Farinati
Marco
M
Zoli
Franco
F
Borzio
Eugenio
E
Caturelli
Maria
M
Chiaramonte
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D005260:Female; D006521:Hepatitis, Chronic / Q000150:complications*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D000637:Transaminases / Q000097:blood
D000637:Transaminases