title: Survival of hepatocellular carcinoma patients is significantly improving: a population-based study from southern Switzerland.
abstract: BACKGROUND
  During the last 20 years, relevant diagnostic procedures and advanced treatments have been progressively introduced in the management of hepatocellular carcinoma (HCC). The aim of the present study was to assess up-to-date survival trends for HCC in southern Switzerland, a region with one of the highest incidence rates in the country.
  
  
  METHODS
  HCCs diagnosed in 1996-2009 were selected by the Ticino Cancer Registry. Cancer-specific survival (CSS) analysis was performed using the Kaplan-Meier method by calendar period: 1996-2000, 2001-2005 and 2006-2009. The log-rank test was used to detect differences in survival curves. Simultaneous assessment of prognostic factors was performed by a multivariate analysis using the Cox proportional-hazards regression model.
  
  
  RESULTS
  619 HCCs were analysed. There was a significant increase of patients undergoing transarterial chemoembolisation (TACE), whereas patients undergoing curative or palliative supportive treatments remained unchanged (p < 0.0001). No shift to earlier stages was detected. Significant differences in CCS were observed by age-group (p < 0.0001), diagnosis period (p < 0.0001), diagnosis technique (p = 0.0035), Barcelona-Clinic liver cancer stage (p < 0.0001), treatment (p < 0.0001). Multivariate analysis confirmed the independent impact on CSS of factors above mentioned, not including the diagnosis technique. Death risk was higher for patients diagnosed in 1996-2000 (HR: 1.32; 95% CI: 1.03; 1.68) and 2001-2005 (HR: 1.33; 95% CI: 1.05; 1.67) in comparison with 2006-2009 (reference group).
  
  
  CONCLUSIONS
  The current population-based report describes a major increase in HCC survival. Simultaneously an increased use of TACE has been detected, probable cofactor of the observed survival increase. Possibly additional efforts could be made to decrease the HCC stage at diagnosis through active surveillance of cirrhotic patients to allow an increase in curative treatments. For sure efforts should be made to comply with a standardised staging system for HCC, particularly for comparative population-based issues.
authors.affiliation: Ticino Cancer Registry, Institute of Pathology, 6600 Locarno, Switzerland.
authors.forename: Andrea
authors.initials: A
authors.lastname: Bordoni
authors.affiliation: Center for Liver Diseases, Luganese Clinic SA, 6900 Lugano, Switzerland.
authors.forename: Andreas
authors.initials: A
authors.lastname: Cerny
authors.affiliation: Hepatology Unit, San Giovanni Hospital, 6500 Bellinzona, Switzerland; Gastroenterology and Hepatology Unit, University Hospital Geneva, 1200 Geneva, Switzerland.
authors.forename: Florian
authors.initials: F
authors.lastname: Bihl
authors.affiliation: Department of Diagnostic and Interventional Radiology, San Giovanni Hospital, 6500 Bellinzona, Switzerland.
authors.forename: Mario
authors.initials: M
authors.lastname: Alerci
authors.affiliation: Ticino Cancer Registry, Institute of Pathology, 6600 Locarno, Switzerland.
authors.forename: Paola
authors.initials: P
authors.lastname: Mazzola
authors.affiliation: Ticino Cancer Registry, Institute of Pathology, 6600 Locarno, Switzerland.
authors.forename: Simona
authors.initials: S
authors.lastname: Peverelli
authors.affiliation: Hepato-Oncology Unit, Oncologic Institute of Italian Switzerland (IOSI), 6500 Bellinzona, Switzerland; Clinical Medicine Unit, S. Anna Clinic, 6924 Sorengo, Switzerland.
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Marini
authors.affiliation: Hepatobiliary Centre, Visceral Surgery and Transplantation Units, University Hospital of Geneva, 1200 Geneva, Switzerland.
authors.forename: Pietro
authors.initials: P
authors.lastname: Majno
authors.affiliation: Clinical Pathology, Institute of Pathology, 6600 Locarno, Switzerland.
authors.forename: Luca
authors.initials: L
authors.lastname: Mazzucchelli
authors.affiliation: Ticino Cancer Registry, Institute of Pathology, 6600 Locarno, Switzerland. Electronic address: alessandra.spitale@ti.ch.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Spitale
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000473:pathology; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D016019:Survival Analysis; D013557:Switzerland; D016896:Treatment Outcome
keywords: Barcelona-Clinic liver cancer staging; Cancer registry; Hepatocellular carcinoma; Survival trend; Treatment