title: The changing scenario of hepatocellular carcinoma over the last two decades in Italy.
abstract: OBJECTIVE
  This study investigates whether the aetiologic changes in liver disease and the improved management of hepatocellular carcinoma (HCC) have modified the clinical scenario of this tumour over the last 20 years in Italy.
  
  
  METHODS
  Retrospective study based on the analysis of the ITA.LI.CA (Italian Liver Cancer) database including 3027 HCC patients managed in 11 centres. Patients were divided into 3 groups according to the period of HCC diagnosis: 1987-1996 (year of the "Milano criteria" publication), 1997-2001 (year of release of the EASL guidelines for HCC), and 2002-2008.
  
  
  RESULTS
  The significant changes were: (1) progressive patient ageing; (2) increasing prevalence of HCV infection until 2001, with a subsequent decrease, when the alcoholic aetiology increased; (3) liver function improvement, until 2001; (4) increasing "incidental" at the expense of "symptomatic" diagnoses, until 2001; (5) unchanged prevalence of tumours diagnosed during surveillance (around 50%), with an increasing use of the 6-month schedule; (6) favourable HCC "stage migration", until 2001; (7) increasing use of percutaneous ablation; (8) improving survival, until 2001.
  
  
  CONCLUSIONS
  Over the last 20 years, several aetiologic and clinical features regarding HCC have changed. The survival improvement observed until 2001 was due to an increasing number of tumours diagnosed in early stages and in a background of compensated cirrhosis, and a growing and better use of locoregional treatments. However, the prevalence of early cancers and survival did not increase further in the last years, a result inciting national policies aimed at implementing surveillance programmes for at risk patients.
authors.affiliation: Dipartimento di Medicina Clinica, Unità di Semeiotica Medica, Alma Mater Studiorum-Università di Bologna, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Santi
authors.forename: Daniela
authors.initials: D
authors.lastname: Buccione
authors.forename: Antonio
authors.initials: A
authors.lastname: Di Micoli
authors.forename: Gianluca
authors.initials: G
authors.lastname: Fatti
authors.forename: Marta
authors.initials: M
authors.lastname: Frigerio
authors.forename: Fabio
authors.initials: F
authors.lastname: Farinati
authors.forename: Paolo
authors.initials: P
authors.lastname: Del Poggio
authors.forename: Gianludovico
authors.initials: G
authors.lastname: Rapaccini
authors.forename: Maria Anna
authors.initials: MA
authors.lastname: Di Nolfo
authors.forename: Luisa
authors.initials: L
authors.lastname: Benvegnù
authors.forename: Marco
authors.initials: M
authors.lastname: Zoli
authors.forename: Franco
authors.initials: F
authors.lastname: Borzio
authors.forename: Edoardo Giovanni
authors.initials: EG
authors.lastname: Giannini
authors.forename: Eugenio
authors.initials: E
authors.lastname: Caturelli
authors.forename: Maria
authors.initials: M
authors.lastname: Chiaramonte
authors.forename: Mauro
authors.initials: M
authors.lastname: Bernardi
authors.forename: Franco
authors.initials: F
authors.lastname: Trevisani
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies