title: The evolutionary scenario of hepatocellular carcinoma in Italy: an update.
abstract: Epidemiology of hepatocellular carcinoma is changing worldwide. This study aimed at evaluating the changing scenario of aetiology, presentation, management and prognosis of hepatocellular carcinoma in Italy during the last 15 years.
  
  
  
  Retrospective analysis of the ITA.LI.CA (Italian Liver Cancer) database including 5192 hepatocellular carcinoma patients managed in 24 centres from 2000 to 2014. Patients were divided into three groups according to the date of cancer diagnosis (2000-2004, 2005-2009 and 2010-2014).
  
  
  
  The main results were as follows: (i) progressive patient aging; (ii) progressive expansion of non-viral cases and, namely, of "metabolic" hepatocellular carcinomas; (iii) increasing proportion of hepatocellular carcinoma diagnosed during a correct (semi-annual) surveillance programme; (iv) favourable cancer stage migration; (v) increased use of radiofrequency ablation to the detriment of percutaneous ethanol injection; (vi) improved outcomes of ablative and transarterial treatments; (vii) improved overall survival (adjusted for the lead time in surveyed patients), particularly after 2009, of both viral and non-viral patients presenting with an early- or intermediate-stage hepatocellular carcinoma.
  
  
  
  During the last 15 years several aetiological and clinical features of hepatocellular carcinoma patients have changed, as their management. The observed improvement of overall survival was owing both to the wider use of semi-annual surveillance, expanding the proportion of tumours that qualified for curative treatments, and to the improved outcome of loco-regional treatments.
authors.affiliation: Unità di Semeiotica Medica, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum - Università di Bologna, Bologna, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Bucci
authors.affiliation: Unità di Semeiotica Medica, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum - Università di Bologna, Bologna, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Garuti
authors.affiliation: Unità di Semeiotica Medica, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum - Università di Bologna, Bologna, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Lenzi
authors.affiliation: Unità di Medicina Interna, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum - Università di Bologna, Bologna, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Pecorelli
authors.affiliation: Unità di Gastroenterologia, Dipartimento di Scienze Chirurgiche e Gastroenterologiche, Università di Padova, Padova, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Farinati
authors.affiliation: Unità di Gastroenterologia, Dipartimento di Medicina Interna, IRCCS-Azienda Ospedaliera Universitaria San Martino-IST, Università di Genova, Genova, Italy.
authors.forename: Edoardo G
authors.initials: EG
authors.lastname: Giannini
authors.affiliation: Unità di Medicina Interna, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum - Università di Bologna, Bologna, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Granito
authors.affiliation: Divisione di Chirurgia, Policlinico San Marco, Zingonia, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Ciccarese
authors.affiliation: Unità di Medicina Interna e Gastroenterologia, Complesso Integrato Columbus, Università Cattolica di Roma, Rome, Italy.
authors.forename: Gian Lodovico
authors.initials: GL
authors.lastname: Rapaccini
authors.affiliation: Divisione di Medicina, Azienda Ospedaliera Bolognini, Seriate, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Di Marco
authors.affiliation: Unità Operativa di Gastroenterologia, Ospedale Belcolle, Viterbo, Italy.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Caturelli
authors.affiliation: Unità di Medicina Interna, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum - Università di Bologna, Bologna, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Zoli
authors.affiliation: Unità di Radiologia, Dipartimento di Medicina, Ospedale Fatebenefratelli, Milan, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Borzio
authors.affiliation: Unità Operativa Gastroenterologia e Malattie del Ricambio, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Sacco
authors.affiliation: Unità di Gastroenterologia, Dipartimento Biomedico di Medicina Interna e Specialistica, Università di Palermo, Palermo, Italy.
authors.forename: Calogero
authors.initials: C
authors.lastname: Cammà
authors.affiliation: Divisione di Medicina Interna, Ospedale Villa Sofia - V. Cervello, Università di Palermo, Palermo, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Virdone
authors.affiliation: Medicina Interna ed Epatologia, Dipartimento di Medicina Sperimentale e Clinica - Università di Firenze, Firenze, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Marra
authors.affiliation: Unità di Gastroenterologia, Ospedale Regionale di Bolzano, Bolzano, Italy.
authors.forename: Martina
authors.initials: M
authors.lastname: Felder
authors.affiliation: Unità di Gastroenterologia, Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli "Federico II", Naples, Italy.
authors.forename: Filomena
authors.initials: F
authors.lastname: Morisco
authors.affiliation: Dipartimento di Medicina Molecolare, Università di Padova, Padua, Italy.
authors.forename: Luisa
authors.initials: L
authors.lastname: Benvegnù
authors.affiliation: Unità di Medicina Interna e Gastroenterologia, Policlinico Gemelli, Università Cattolica di Roma, Rome, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Gasbarrini
authors.affiliation: Dipartimento di Gastroenterologia, Gastroenterologia, Politecnico-Università delle Marche, Ancona, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Svegliati-Baroni
authors.affiliation: Dipartimento di Medicina Interna, Ospedale per gli Infermi di Faenza, Faenza, Italy.
authors.forename: Francesco Giuseppe
authors.initials: FG
authors.lastname: Foschi
authors.affiliation: Unità di Malattie Infettive ed Epatologia, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Missale
authors.affiliation: Unità di Gastroenterologia, Ospedale Sacro Cuore Don Calabria, Negrar, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Masotto
authors.affiliation: Dipartimento di Medicina Clinica e Chirurgia, Unità di Epato-Gastroenterologia, Università di Napoli "Federico II", Naples, Italy.
authors.forename: Gerardo
authors.initials: G
authors.lastname: Nardone
authors.affiliation: Unità di Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum - Università di Bologna, Bologna, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Colecchia
authors.affiliation: Unità di Semeiotica Medica, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum - Università di Bologna, Bologna, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Bernardi
authors.affiliation: Unità di Semeiotica Medica, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum - Università di Bologna, Bologna, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Trevisani
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology*; D017115:Catheter Ablation; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008113:Liver Neoplasms / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D017678:Sex Distribution; D055815:Young Adult; D000509:alpha-Fetoproteins / Q000032:analysis
chemical_list: D000509:alpha-Fetoproteins
keywords: epidemiology; hepatocellular carcinoma; survival; treatment