title: Hepatocellular carcinoma in a large Canadian urban centre: stage at treatment and its potential determinants.
abstract: OBJECTIVE
  To determine whether there is a significant difference in tumour stage between patients initially found with hepatocellular carcinoma (HCC) at a tertiary hepatobiliary centre and patients referred with tumours detected elsewhere; and to determine variables associated with referral in a palliative stage.
  
  
  METHODS
  A retrospective review of 12,199 patients seen at a liver clinic over a 10.5-year period revealed 236 patients with HCC first detected internally (internal) and 163 who were referred with a known mass (referred). All patients were staged at the time of treatment using the Milan criteria for transplantation and Barcelona Clinic Liver Cancer (BCLC) staging system. Curative disease was defined as BCLC stages 0 and A. In the referred group, univariate and multivariate analyses were used to determine which of the following factors were significantly associated with presentation in a palliative stage: age, sex, ethnicity, cause of liver disease, presence of cirrhosis, location of residence and quintile of neighbourhood income.
  
  
  RESULTS
  In comparing the internal versus referred patients, significant differences were found in the proportion of patients fulfilling Milan criteria (72% versus 36%), those with curative disease (75% versus 49%) and those with very early stage tumour (BCLC stage 0, 23% versus 7%); all differences were statistically significant (P<0.001). In patients referred for treatment of HCC from an outside institution, none of the variables tested were associated with presentation in a palliative stage.
  
  
  CONCLUSIONS
  Patients with HCC referred to a liver treatment centre were more likely to be in palliative stages than those whose tumour was detected internally.
authors.forename: Korosh
authors.initials: K
authors.lastname: Khalili
authors.forename: Ravi
authors.initials: R
authors.lastname: Menezes
authors.forename: Leyla Kochak
authors.initials: LK
authors.lastname: Yazdi
authors.forename: Hyun-Jung
authors.initials: HJ
authors.lastname: Jang
authors.forename: Tae Kyoung
authors.initials: TK
authors.lastname: Kim
authors.forename: Suraj
authors.initials: S
authors.lastname: Sharma
authors.forename: Jordan
authors.initials: J
authors.lastname: Feld
authors.forename: Morris
authors.initials: M
authors.lastname: Sherman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery; D003657:Decision Making; D005260:Female; D006786:Hospitals, Urban; D006801:Humans; D008113:Liver Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009864:Ontario / Q000453:epidemiology; D011159:Population Surveillance; D012017:Referral and Consultation; D012189:Retrospective Studies; D016896:Treatment Outcome