title: A 30-year, population-based study shows improved management and prognosis of hepatocellular carcinoma.
abstract: OBJECTIVE
  Little is known about the impact of changes in the management of hepatocellular carcinoma (HCC) over time. We assessed trends in the pattern of care and in prognosis at a population level.
  
  
  METHODS
  Data on diagnostic conditions, treatment, and prognosis from 1976-2005 were collected by the population-based digestive cancer registry of Burgundy (France). A nonconditional logistic regression was used to identify factors associated with treatment for cure. A multivariate relative survival analysis was also performed.
  
  
  RESULTS
  The context of HCC diagnosis has changed; the proportion of asymptomatic patients increased from 5.6% (1976-1985) to 37.2% (1996-2005). The proportion of cases diagnosed on the basis of morphologic criteria increased from 14% during 1976-1985 to 35.6% during 1996-2005, whereas histologically verified cases decreased from 62.2% to 41.2% between the same time periods. The proportion of patients who were treated with intent to cure increased from 2.7% (1976-1985) to 19.6% (1996-2005). This increase was associated with improvements in relative survival from 4.7% (1976-1985) to 32.8% (1996-2005) at 1 year and from 1.4% to 10.0% at 5 years. The 5-year relative survival of patients treated with curative intent increased, reaching 46.6% for the 1996-2005 period. In the multivariate relative survival analysis, age, period of diagnosis, clinical presentation, alpha-fetoprotein level, and treatment were independent prognostic factors.
  
  
  CONCLUSIONS
  During a 30-year period, there was an increase in the number of HCCs diagnosed in asymptomatic subjects that was associated with the development of new effective therapies; this association might account for improvements in prognosis of patients with HCC.
authors: CHU University Hospital, Dijon, France. Boris.guiu@chudijon.fr
authors: Boris
authors: B
authors: Guiu
authors: Anne
authors: A
authors: Minello
authors: Vanessa
authors: V
authors: Cottet
authors: Côme
authors: C
authors: Lepage
authors: Patrick
authors: P
authors: Hillon
authors: Jean
authors: J
authors: Faivre
authors: Anne-Marie
authors: AM
authors: Bouvier
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology / Q000628:therapy*; D005260:Female; D005602:France / Q000453:epidemiology; D006651:Histocytochemistry / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011859:Radiography / Q000379:methods / Q000706:statistics & numerical data; D016019:Survival Analysis; D016896:Treatment Outcome; D014463:Ultrasonography / Q000379:methods / Q000706:statistics & numerical data