title: Factors that affect risk for hepatocellular carcinoma and effects of surveillance.
abstract: OBJECTIVE
  The incidence of hepatocellular carcinoma (HCC) in the United States is increasing. Surveillance may affect the stage at diagnosis and consequently the treatment options available for HCC. We evaluated risk factors for HCC, the proportion of cases detected via surveillance, tumor characteristics, treatment approaches, and overall patient survival in a referral center cohort.
  
  
  METHODS
  The study included all patients diagnosed with HCC at the Mayo Clinic, Rochester, Minnesota, from 2007 to 2009 (n = 460). Clinical information was retrospectively abstracted from the medical record.
  
  
  RESULTS
  Hepatitis C virus (HCV, 36%), alcohol use (29%), and nonalcoholic fatty liver disease (NAFLD, 13%) were the most common risk factors for HCC. HCV was present in 56% of patients younger than 60. NAFLD was present in 19% of patients older than 60. HCC was detected during surveillance in 31% of patients. Patients with worse liver function were more likely to be on surveillance. Transarterial chemoembolization, surgical resection, and liver transplantation were the most common treatment approaches for HCC. Patients diagnosed with HCC during surveillance had less advanced disease, were more likely to be eligible for potentially curative treatments, and had increased survival times (P < .001).
  
  
  CONCLUSIONS
  At a major US referral center, the predominant HCC etiologies were HCV, alcohol use, and NAFLD. HCCs were detected during surveillance in the minority of patients. HCCs detected during surveillance were of less advanced stage, and patients were more likely to receive treatment that prolonged their survival.
authors: Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors: Ju Dong
authors: JD
authors: Yang
authors: William S
authors: WS
authors: Harmsen
authors: Seth W
authors: SW
authors: Slettedahl
authors: Roongruedee
authors: R
authors: Chaiteerakij
authors: Felicity T
authors: FT
authors: Enders
authors: Terry M
authors: TM
authors: Therneau
authors: Lucinda
authors: L
authors: Orsini
authors: W Ray
authors: WR
authors: Kim
authors: Lewis R
authors: LR
authors: Roberts
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D005234:Fatty Liver / Q000150:complications / Q000453:epidemiology; D005235:Fatty Liver, Alcoholic / Q000150:complications / Q000453:epidemiology; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D065626:Non-alcoholic Fatty Liver Disease; D012189:Retrospective Studies; D012307:Risk Factors; D018571:Sentinel Surveillance; D016019:Survival Analysis