title: Relative decrease in the role played by hepatitis B virus infection in the aetiology of hepatocellular carcinoma during a 20-year period: a multicentre Italian study.
abstract: BACKGROUND
  Chronic hepatitis B virus (HBV) infection is one of the most frequent aetiological factors associated with the development of hepatocellular carcinoma (HCC).
  
  
  OBJECTIVE
  This study evaluated the temporal trend in the aetiological role played by HBV infection alone in patients diagnosed with HCC during the last 20 years in Italy.
  
  
  METHODS
  Among the 2042 HCC patients included in the Italian Liver Cancer (ITA.LI.CA.) database, 346 had chronic HBV infection alone. We assessed the proportion of HCC patients with HBV infection in four quinquennia (1987-1991, 1992-1996, 1997-2001, 2002-2006) and evaluated their main clinical, virological and oncological characteristics across these periods.
  
  
  RESULTS
  Although the absolute number increased, the proportion of HBV-related HCC relatively decreased over time from 26.7% (47/176 patients) in 1987-1991 to 14.7% (127/862 patients) in 2002-2006 (P=0.0005). Patients' demographical, clinical and virological characteristics were similar across the four quinquennia. A greater proportion of patients was diagnosed with non-advanced HCC in more recent years (from 26% in 1987-1991 to 48% in 2002-2006, P=0.025), likely owing to a growing use of semiannual surveillance (from 63% in 1987-1991 to 80% in 2002-2006).
  
  
  CONCLUSIONS
  We observed a significant, relative decrease in the role played by chronic HBV infection alone in the determinism of HCC during the last 20 years. In recent years, more patients are diagnosed with non-advanced HCC probably owing to improvements in HCC detection.
authors.affiliation: Dipartimento di Medicina Interna, University of Genoa, Genoa, Italy. egiannini@unige.it
authors.forename: Edoardo G
authors.initials: EG
authors.lastname: Giannini
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Savarino
authors.forename: Domenico
authors.initials: D
authors.lastname: Risso
authors.forename: Maria A
authors.initials: MA
authors.lastname: Di Nolfo
authors.forename: Paolo
authors.initials: P
authors.lastname: Del Poggio
authors.forename: Luisa
authors.initials: L
authors.lastname: Benvegnù
authors.forename: Fabio
authors.initials: F
authors.lastname: Farinati
authors.forename: Marco
authors.initials: M
authors.lastname: Zoli
authors.forename: Franco
authors.initials: F
authors.lastname: Borzio
authors.forename: Eugenio
authors.initials: E
authors.lastname: Caturelli
authors.forename: Maria
authors.initials: M
authors.lastname: Chiaramonte
authors.forename: Franco
authors.initials: F
authors.lastname: Trevisani
mesh_terms: D001663:Bilirubin / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology* / Q000209:etiology*; D006509:Hepatitis B / Q000150:complications* / Q000453:epidemiology*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008113:Liver Neoplasms / Q000453:epidemiology* / Q000209:etiology*; D009367:Neoplasm Staging; D012709:Serum Albumin / Q000032:analysis; D018709:Statistics, Nonparametric
chemical_list: D012709:Serum Albumin; D001663:Bilirubin