title: Clinical characteristics of patients with hepatocellular carcinoma in Austria - is there a need for a structured screening program?
abstract: BACKGROUND
  We investigated the differences in clinical presentation of patients with hepatocellular carcinoma (HCC) at the time of diagnosis, before and after the publication of the European Association for the study of the Liver (EASL) guidelines of HCC management and screening.
  
  
  METHODS
  Between 1991 and 2009, 907 patients were diagnosed with HCC at our department of which 850 were included in this study. Data regarding demography, liver function and tumor stage at the time of diagnosis were retrospectively collected. Differences in clinical characteristics and overall survival (OS) were compared before (period 1) and after (period 2) the publication of the EASL guidelines in 2001.
  
  
  RESULTS
  In period 2, patients were more likely to be overweight (BMI: 26.1 vs. 27.5, p = 0.003), suffered more often from diabetes (25.4 vs. 37.3%, p = 0.001) and nonalcoholic steatohepatitis (NASH) (0.7 vs. 5.1%, p < 0.001). Alcoholic liver disease replaced viral hepatitis as the main etiology but not in the increasing number of patients with migration background where viral hepatitis (76.3%) remained the predominant etiology. No change in liver function and tumor stages at the time of HCC diagnosis was observed. Most patients presented with advanced incurable HCC. However, the median OS of all HCC patients increased in period 2 (7 vs. 14 months, p < 0.001) suggesting improvements of palliative therapy.
  
  
  CONCLUSIONS
  Patients with HCC are still predominantly diagnosed at incurable tumor stages, despite explicit European screening guidelines existing since 9 years. The implementation of a HCC surveillance program for cirrhotic patients in Austria seems to be warranted.
authors.affiliation: Department of Gastroenterology and Hepatology, AKH and Medical University Vienna, Vienna, Austria.
authors.forename: Florian
authors.initials: F
authors.lastname: Hucke
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Sieghart
authors.forename: Maximilian
authors.initials: M
authors.lastname: Schöniger-Hekele
authors.forename: Markus
authors.initials: M
authors.lastname: Peck-Radosavljevic
authors.forename: Christian
authors.initials: C
authors.lastname: Müller
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001317:Austria; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000473:pathology; D003430:Cross-Sectional Studies; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000473:pathology; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009367:Neoplasm Staging; D012307:Risk Factors; D016019:Survival Analysis; D055815:Young Adult