title: Hepatocellular carcinoma in patients without cirrhosis in Italy.
abstract: BACKGROUND
  In the Western world, hepatocellular carcinoma seldom develops in patients without cirrhosis, and reports describing the characteristics of non-cirrhotic patients with hepatocellular carcinoma are rather infrequent.
  
  
  METHODS
  We evaluated the main clinical characteristics, treatment options, and survival of patients with hepatocellular carcinoma developed in non-cirrhotic liver among the 3027 consecutive cases of hepatocellular carcinoma accrued in the Italian Liver Cancer database during the last 20 years.
  
  
  RESULTS
  We identified 52 patients with hepatocellular carcinoma in non-cirrhotic livers (1.7% of all hepatocellular carcinomas), 42 with (80.8%) and 10 without (19.2%) chronic liver disease. In patients without chronic liver disease, median tumour diameter was greater compared to patients with chronic liver disease (7.8 versus 4.0 cm, P=0.046). Curative treatment was feasible in 20 patients (38.5%). Median overall survival was 26 months and 5-year survival rate was 23.7%. Detection of hepatocellular carcinoma outside surveillance (P=0.036), advanced hepatocellular carcinoma stage (P<0.0001), and non-curative treatment (P=0.007) were associated with worse prognosis, but tumour stage was the only independent predictor of survival.
  
  
  CONCLUSIONS
  In Italy, less than 2% of hepatocellular carcinomas develop in a non-cirrhotic liver, and almost never in a normal liver. These patients frequently present with advanced tumours, have low eligibility rates for curative treatment, and have a dismal prognosis despite their preserved liver function.
authors.affiliation: Department of Internal Medicine, Gastroenterology Unit, University of Genoa, Genoa, Italy. egiannini@unige.it
authors.forename: Edoardo G
authors.initials: EG
authors.lastname: Giannini
authors.forename: Simona
authors.initials: S
authors.lastname: Marenco
authors.forename: Linda
authors.initials: L
authors.lastname: Bruzzone
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Savarino
authors.forename: Fabio
authors.initials: F
authors.lastname: Farinati
authors.forename: Paolo
authors.initials: P
authors.lastname: Del Poggio
authors.forename: Gian Ludovico
authors.initials: GL
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: 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: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008103:Liver Cirrhosis / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology; D008113:Liver Neoplasms / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult