title: Rise and fall of HCV-related hepatocellular carcinoma in Italy: a long-term survey from the ITA.LI.CA centres.
abstract: OBJECTIVE
  Hepatitis C virus (HCV) is the leading aetiological factor of HCC in the western world where, overall, its incidence is increasing, despite data suggesting an initial drop in some areas. The aim of this study was to evaluate epidemiology, clinical features and survival of HCV-related HCC (HCV-HCC) in a wide time range in Italy.
  
  
  METHODS
  Multicentre retrospective study including 3695 patients prospectively recruited by the ITA.LI.CA group. Patients were classified into three subgroups according to aetiology (Group A[GA], pure HCV; Group B[GB], HCV + cofactors; and Group C[GC], non-HCV) and in 5 time cohorts (5 years each), according to the year of diagnosis. Age, gender, Child-Pugh score, modality of diagnosis, stage, presence of thrombosis/metastases, type of treatment and survival were analysed.
  
  
  RESULTS
  A total of 1801 GA patients, 445 GB and 1333 GC were recruited. The number of GA patients peaked in the 1996-2000, gradually dropping thereafter (P < 0.0001), as observed for GB (P < 0.0001). Age at diagnosis increased (P < 0.0001), while percentage of patients diagnosed during surveillance and stage improved only in GA (P = 0.02 and P = 0.003 respectively). The survival significantly increased over time particularly in GA (median 37 months) and was longer in GA than in GB and GC (P < 0.0001).
  
  
  CONCLUSIONS
  The prevalence of HCC-HCV is decreasing in Italy since 2001. HCV-HCC patients are older, more frequently diagnosed under surveillance and in an earlier stage. HCC survival improved in the last 15 years and is significantly higher in patients with HCV-HCC. We therefore expect a further drop in both incidence and mortality for HCV-HCC in the years to come.
authors.affiliation: Dipartimento di Scienze Chirurgiche Oncologiche e Gastroenterologiche "P.G. Cevese", Università degli Studi di Padova, Padova, Italia.
authors.forename: Nora
authors.initials: N
authors.lastname: Cazzagon
authors.forename: Franco
authors.initials: F
authors.lastname: Trevisani
authors.forename: Gemma
authors.initials: G
authors.lastname: Maddalo
authors.forename: Anna
authors.initials: A
authors.lastname: Giacomin
authors.forename: Veronica
authors.initials: V
authors.lastname: Vanin
authors.forename: Caterina
authors.initials: C
authors.lastname: Pozzan
authors.forename: Paolo Del
authors.initials: PD
authors.lastname: Poggio
authors.forename: Gianludovico
authors.initials: G
authors.lastname: Rapaccini
authors.forename: Anna M Di
authors.initials: AM
authors.lastname: 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 G
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: Francesco G
authors.initials: FG
authors.lastname: Foschi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Cabibbo
authors.forename: Martina
authors.initials: M
authors.lastname: Felder
authors.forename: Francesca
authors.initials: F
authors.lastname: Ciccarese
authors.forename: Gabriele
authors.initials: G
authors.lastname: Missale
authors.forename: Gianluca Svegliati
authors.initials: GS
authors.lastname: Baroni
authors.forename: Filomena
authors.initials: F
authors.lastname: Morisco
authors.forename: Anna
authors.initials: A
authors.lastname: Pecorelli
authors.forename: Fabio
authors.initials: F
authors.lastname: Farinati
mesh_terms: D000367:Age Factors; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology / Q000821:virology; D005260:Female; D006526:Hepatitis C / Q000150:complications* / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008113:Liver Neoplasms / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology / Q000821:virology; D008297:Male; D015995:Prevalence; D012189:Retrospective Studies; D012737:Sex Factors; D016019:Survival Analysis
keywords: cirrhosis; hepatitis C; hepatocellular carcinoma