title: Changing aetiological factors of hepatocellular carcinoma and their potential impact on the effectiveness of surveillance.
abstract: BACKGROUND
  The aetiological factors of hepatocellular carcinoma may vary over time.
  
  
  OBJECTIVE
  The study assessed the potential impact of the aetiological factors on the effectiveness of surveillance in real-world patients.
  
  
  METHODS
  Multicentre, cross-sectional study enrolling consecutive hepatocellular carcinoma cases during a six month period.
  
  
  RESULTS
  1733 cases (1311 prevalent and 422 incident) were recruited (mean age 68.6 years; 46.1% cases over 70 years; 73.9% males; 95.3% with cirrhosis); 63.0% were hepatitis C virus positive and 23.7% were virus negative. Amongst incident HCCs, 34.5% were single ≤3cm and 54.4% met the Milan criteria; 61.6% were diagnosed during surveillance; virus negative patients showed the lowest rate of surveillance (51.0%). Surveillance was an independent predictor of detecting single HCCs ≤2cm (O.R.=5.4; 95% C.I.=2.4-12.4) or HCCs meeting the Milan criteria (O.R.=3.1; 95% C.I.=1.9-5.2). Compared with an earlier Italian survey, there was a higher proportion of elderly subjects (P<0.01), Child-Pugh class A cases (P<0.01), of virus-negative patients (P<0.01) and with single tumours ≤3cm (P<0.01) and a lower prevalence of hepatitis C virus positive individuals (P<0.01).
  
  
  CONCLUSIONS
  HCC is characterised by a growing prevalence of elderly patients and cases unrelated to hepatitis virus infections. The application of surveillance must be implemented, particularly amongst non-viral patients.
authors.affiliation: Dipartimento Malattie Infettive e Tropicali, Policlinico Umberto I, Rome, Italy.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Stroffolini
authors.forename: Franco
authors.initials: F
authors.lastname: Trevisani
authors.forename: Giovanbattista
authors.initials: G
authors.lastname: Pinzello
authors.forename: Franco
authors.initials: F
authors.lastname: Brunello
authors.forename: Maurizio A
authors.initials: MA
authors.lastname: Tommasini
authors.forename: Massimo
authors.initials: M
authors.lastname: Iavarone
authors.forename: Vito
authors.initials: V
authors.lastname: Di Marco
authors.forename: Fabio
authors.initials: F
authors.lastname: Farinati
authors.forename: Paolo
authors.initials: P
authors.lastname: Del Poggio
authors.forename: Franco
authors.initials: F
authors.lastname: Borzio
authors.forename: Mauro
authors.initials: M
authors.lastname: Borzio
authors.forename: Eugenio
authors.initials: E
authors.lastname: Caturelli
authors.forename: Maria Anna
authors.initials: MA
authors.lastname: Di Nolfo
authors.forename: Marta
authors.initials: M
authors.lastname: Frigerio
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Brancaccio
authors.forename: Giovanni Battista
authors.initials: GB
authors.lastname: Gaeta
mesh_terms: D017677:Age Distribution; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D003430:Cross-Sectional Studies; D005260:Female; D006514:Hepatitis B Surface Antigens / Q000097:blood; D018937:Hepatitis C Antibodies / Q000097:blood; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008103:Liver Cirrhosis / Q000150:complications* / Q000000981:diagnostic imaging; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011159:Population Surveillance; D015995:Prevalence; D014463:Ultrasonography
chemical_list: D006514:Hepatitis B Surface Antigens; D018937:Hepatitis C Antibodies