title: Practical Considerations of Real Life of Hepatocellular Carcinoma in a Tertiary Center of Brazil.
abstract: Hepatocellular carcinoma (HCC) is the most common malignancy that develops in cirrhotic livers. Its clinical and epidemiological characteristics and mortality rates vary according to geographical region. The objective of this study was to evaluate the clinical profile, epidemiological characteristics, laboratory parameters, treatment and survival of patients with HCC.
  
  
  
  Patients with HCC seen between 2000 and 2012 were studied. The Kaplan-Meier method was used for survival analysis according to variables in question.
  
  
  
  The study included 247 patients with a mean age of 60 ± 10 years. There was a predominance of males (74%). The main etiologies of HCC were HCV infection (55%), excessive alcohol consumption (12%), and HBV infection (8%). Liver cirrhosis was present in 92% of cases. The mean tumor number and diameter were 2 and 5 cm, respectively. Patients meeting the Milan criteria corresponded to 43% of the sample. Liver transplantation was performed in 22.4% of patients of the Milan subset and in 10% of the whole sample. The overall mean survival was 60 months, with a 1-, 3- and 5-year survival probability of 74%, 40% and 29%, respectively. Lower survival was observed among patients with alcoholic etiology. Survival was higher among patients submitted to liver transplantation (P &amp;lt; 0.001), TACE (P &amp;lt; 0.001), or any kind of treatment (P &amp;lt; 0.001). However, no difference was found for surgical resection (P = 0.1) or sorafenib (P = 0.1).
  
  
  
  Patients with HCC were mainly older men diagnosed at an advanced stage. Treatment was associated with better overall survival, but few patients survived to be treated.
authors.affiliation: Department of Gastroenterology, Hepatology Unit. Federal University of Sao Paulo (Unifesp), Sao Paulo, SP, Brazil.
authors.forename: Sandra R
authors.initials: SR
authors.lastname: Almeida-Carvalho
authors.affiliation: Department of Gastroenterology, Hepatology Unit. Federal University of Sao Paulo (Unifesp), Sao Paulo, SP, Brazil.
authors.forename: Maria L
authors.initials: ML
authors.lastname: Gomes-Ferraz
authors.affiliation: Department of Gastroenterology, Hepatology Unit. Federal University of Sao Paulo (Unifesp), Sao Paulo, SP, Brazil.
authors.forename: Carla A
authors.initials: CA
authors.lastname: Loureiro-Matos
authors.affiliation: Department of Gastroenterology, Hepatology Unit. Federal University of Sao Paulo (Unifesp), Sao Paulo, SP, Brazil.
authors.forename: Antônio E
authors.initials: AT
authors.lastname: Benedito-Silva
authors.affiliation: Department of Gastroenterology, Hepatology Unit. Federal University of Sao Paulo (Unifesp), Sao Paulo, SP, Brazil.
authors.forename: Roberto J
authors.initials: RJ
authors.lastname: Carvalho-Filho
authors.affiliation: Department of Surgery, Liver Transplant Unit. Federal University of Sao Paulo (Unifesp), Sao Paulo, SP, Brazil.
authors.forename: Rogério
authors.initials: R
authors.lastname: Renato-Perez
authors.affiliation: Department of Surgery, Liver Transplant Unit. Federal University of Sao Paulo (Unifesp), Sao Paulo, SP, Brazil.
authors.forename: Adriano
authors.initials: A
authors.lastname: Miziara-Gonzalez
authors.affiliation: Department of Pediatric Surgery. Federal University of Sao Paulo (Unifesp), Sao Paulo, SP, Brazil.
authors.forename: Alcides  A
authors.initials: AA
authors.lastname: Salzedas-Netto
authors.affiliation: Department of Diagnostic Radiology. Federal University of Sao Paulo (Unifesp), Sao Paulo, SP, Brazil.
authors.forename: Denis
authors.initials: D
authors.lastname: Szejnfeld
authors.affiliation: Department of Diagnostic Radiology. Federal University of Sao Paulo (Unifesp), Sao Paulo, SP, Brazil.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: D'Ippolito
authors.affiliation: Department of Diagnostic Pathology. Federal University of Sao Paulo (Unifesp), Sao Paulo, SP, Brazil.
authors.forename: Valéria
authors.initials: V
authors.lastname: Pereira-Lanzoni
authors.affiliation: Department of Gastroenterology, Hepatology Unit. Federal University of Sao Paulo (Unifesp), Sao Paulo, SP, Brazil.
authors.forename: Ivonete
authors.initials: I
authors.lastname: Souza-Silva
mesh_terms: D055011:Ablation Techniques / Q000009:adverse effects / Q000401:mortality; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001938:Brazil / Q000453:epidemiology; D006528:Carcinoma, Hepatocellular / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009536:Niacinamide / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010671:Phenylurea Compounds / Q000009:adverse effects / Q000627:therapeutic use*; D012307:Risk Factors; D000077157:Sorafenib; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden
chemical_list: D000970:Antineoplastic Agents; D010671:Phenylurea Compounds; D009536:Niacinamide; D000077157:Sorafenib
keywords: Liver Transplantation; Survival; viral hepatitis