Role of aetiology, diabetes, tobacco smoking and hypertension in hepatocellular carcinoma survival.
BACKGROUND
Aim of this study was to investigate the role of aetiology, diabetes, tobacco smoking and hypertension in the survival of patients with hepatocellular carcinoma.


METHODS
A prospective cohort of 552 patients (81.5% males, mean age 64.4 years) first diagnosed with hepatocellular carcinoma in 1995-2001 in Brescia, Italy, was retrospectively analyzed. Data on the presence of diabetes mellitus, hypertension, heavy alcohol intake and tobacco smoking were obtained from patients' clinical charts or interviews. Survival analysis was performed using univariate and multivariate methods (Cox proportional hazards model).


RESULTS
33% had a history of heavy alcohol intake, 24.3% had viral hepatitis and 33.5% had both aetiologies. Diabetes, hypertension and tobacco smoking were found in 29.9%, 37.9% and 35.9%, respectively. During follow-up (median 19.9 months), the median survival was 19.9 (95% confidence interval [CI] 16.7-22.8) months. Using multivariate Cox regression models, alcohol-related liver disease and diabetes were found to be associated with mortality, with hazard ratios of 1.32 (95% CI 0.99-1.75) and 1.25 (95% CI 1.02-1.54), respectively. Hypertension and smoking habit did not influence survival.


CONCLUSIONS
Alcohol aetiology and the presence of diabetes were positively associated with patient mortality with hepatocellular carcinoma, whereas tobacco smoking and hypertension were not.
Unit of Hygiene, Epidemiology and Public Health, Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy. Electronic address: e.raffetti@unibs.it.
Elena
E
Raffetti
Surgical Clinic, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
Nazario
N
Portolani
Surgical Clinic, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
Sarah
S
Molfino
Surgical Clinic, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
Gian Luca
GL
Baiocchi
Unit of Hygiene, Epidemiology and Public Health, Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
Rosa Maria
RM
Limina
Unit of Hygiene, Epidemiology and Public Health, Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
Giovanni
G
Caccamo
Unit of Hygiene, Epidemiology and Public Health, Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
Rossella
R
Lamera
Unit of Hygiene, Epidemiology and Public Health, Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
Francesco
F
Donato
D000368:Aged; D000437:Alcoholism / Q000453:epidemiology*; D006528:Carcinoma, Hepatocellular / Q000209:etiology / Q000401:mortality*; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D006521:Hepatitis, Chronic / Q000150:complications*; D006525:Hepatitis, Viral, Human / Q000150:complications*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D007558:Italy / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications*; D008113:Liver Neoplasms / Q000209:etiology / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology*; D015996:Survival Rate
Attributable risk; Clinical-pathologic features; Prognosis