title: Clinical characteristics of hepatocellular carcinoma in Spain. Comparison with the 2008-2009 period and analysis of the causes of diagnosis out of screening programs. Analysis of 686 cases in 73 centers.
abstract: OBJECTIVE
  In 2010 we published that 53% of cases of hepatocellular carcinoma (HCC) detected in Spain were diagnosed outside the context of standard screening programs, which consequently leads to lower survival rates. The aim of this study was to analyze the current situation and the causes of diagnosis out of screening programs.
  
  
  METHODS
  Prospective registry of 73 second- and third-level Spanish healthcare centers carried out between October 1, 2014 and January 31, 2015. The baseline characteristics of the disease and the first treatment administered for the incidental primary liver tumors during such period were recorded.
  
  
  RESULTS
  A total of 720 patients were included in the study: HCC (n=686), intrahepatic cholangiocarcinoma (n=29), hepatic cholangiocarcinoma (n=2), other (n=3). HCC characteristics: male 82%; mean age 67 years; cirrhosis 87%; main etiologies: alcohol 35%, HCV 30%, alcohol and HCV 15%, non-alcoholic fatty liver disease 6%; tumor stage: BCLC-0 11%, A 43%, B 19%, C 16% and D 11%; first treatment: transarterial chemoembolization (23%), percutaneous ablation (22%), symptomatic treatment (20%), resection (11%), sorafenib (11%). Three hundred and fifty-six patients (53%) were diagnosed outside of screening programs, mainly owing to the fact that they suffered from an undiagnosed liver disease (76%) and to the poor adherence to the screening program (18%). These patients were mainly male (P<.001), with an alcoholic etiology (P<.001) and active alcohol consumption (P<.001). Moreover, the disease was predominantly diagnosed at more advanced stages (P<.001) and was addressed with less radical treatments (P<.001).
  
  
  CONCLUSIONS
  In Spain, the main cause of diagnosis of a HCC outside the context of a screening program is the absence of a prior diagnosis of a liver disease, particularly in alcohol-consuming men. Detecting a liver disease in asymptomatic populations and improving adherence to screening programs are the main areas that must be subject to improvement in order to improve the early detection of HCC.
authors.affiliation: Servicio de Digestivo, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, España.
authors.forename: Carlos
authors.initials: C
authors.lastname: Rodríguez de Lope
authors.affiliation: Servicio de Hepatología, Hospital Clínic, Barcelona Clinic Liver Cancer (BCLC), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, España.
authors.forename: María
authors.initials: M
authors.lastname: Reig
authors.affiliation: Servicio de Digestivo, Hospital General Universitario Gregorio Marañón, Madrid, España.
authors.forename: Ana
authors.initials: A
authors.lastname: Matilla
authors.affiliation: Unidad de Gestión Clínica de Enfermedades Digestivas, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, España.
authors.forename: María Teresa
authors.initials: MT
authors.lastname: Ferrer
authors.affiliation: Servicio de Digestivo, Sección de Hepatología, Hospital de Bellvitge, Universitat Autónoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, España.
authors.forename: Eva
authors.initials: E
authors.lastname: Dueñas
authors.affiliation: Servicio de Medicina Interna-Hepatología, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (VHIR), Universitat Autónoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, España.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Mínguez
authors.affiliation: Servicio de Digestivo, Complexo Hospitalario Universitario de Santiago, Santiago de Compostela, La Coruña, España.
authors.forename: Javier
authors.initials: J
authors.lastname: F Castroagudín
authors.affiliation: Servicio de Digestivo, Hospital Dr. Peset, Valencia, España.
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Ortiz
authors.affiliation: Unidad Hepática, Servicio de Digestivo, Hospital General Universitario de Alicante, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Alicante, España.
authors.forename: Sonia
authors.initials: S
authors.lastname: Pascual
authors.affiliation: Sección de Hepatología, Servicio de Digestivo, Hospital Universitario Ramón y Cajal, Madrid, España.
authors.forename: José Luis
authors.initials: JL
authors.lastname: Lledó
authors.affiliation: Servicio de Digestivo, Hospital de la Santa Creu i Sant Pau, Barcelona, España.
authors.forename: Adolfo
authors.initials: A
authors.lastname: Gallego
authors.affiliation: Servicio de Digestivo, Hospital General Universitario de Donosti, San Sebastián, Guipúzcoa, España.
authors.forename: Juan I
authors.initials: JI
authors.lastname: Arenas
authors.affiliation: Servicio de Digestivo, Hospital Universitario Arnau de Vilanova, Institut de Recerca Biomèdica de Lleida (IRBLleida), Lleida, España.
authors.forename: Carles
authors.initials: C
authors.lastname: Aracil
authors.affiliation: Servicio de Digestivo, Mútua de Terrassa, Terrassa, Barcelona, España.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Forne
authors.affiliation: Sección de Hepatología, Servicio de Digestivo, Hospital 12 de Octubre, Madrid, España.
authors.forename: Carolina
authors.initials: C
authors.lastname: Muñoz
authors.affiliation: Sección de Hepatología, Servicio de Digestivo, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España.
authors.forename: Fernando
authors.initials: F
authors.lastname: Pons
authors.affiliation: Servicio de Digestivo, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, España.
authors.forename: Margarita
authors.initials: M
authors.lastname: Sala
authors.affiliation: Sección de Hepatología, Servicio de Medicina Interna, Clínica Universitaria de Navarra, Pamplona, Navarra, España.
authors.forename: Mercedes
authors.initials: M
authors.lastname: Iñarrairaegui
authors.affiliation: Servicio de Aparato Digestivo, Hospital Moisés Broggi, Sant Joan Despí, Barcelona, España.
authors.forename: Marta
authors.initials: M
authors.lastname: Martin-Llahi
authors.affiliation: Servicio de Digestivo, Hospital de Viladecans, Viladecans, Barcelona, España.
authors.forename: Victoria
authors.initials: V
authors.lastname: Andreu
authors.affiliation: Servicio de Aparato Digestivo, Hospital Virgen de la Arrixaca, Murcia, España.
authors.forename: Carmen
authors.initials: C
authors.lastname: Garre
authors.affiliation: Servicio de Digestivo, Hospital Universitario Puerta del Mar, Cádiz, España.
authors.forename: Paloma
authors.initials: P
authors.lastname: Rendón
authors.affiliation: Servicio de Digestivo, Hospital Universitario Miguel Servet, Zaragoza, España.
authors.forename: Javier
authors.initials: J
authors.lastname: Fuentes
authors.affiliation: Servicio de Digestivo, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, España.
authors.forename: Javier
authors.initials: J
authors.lastname: Crespo
authors.affiliation: Sección de Hepatología, Servicio de Aparato Digestivo, Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Asturias, España.
authors.forename: Manuel
authors.initials: M
authors.lastname: Rodríguez
authors.affiliation: Servicio de Hepatología, Hospital Clínic, Barcelona Clinic Liver Cancer (BCLC), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, España.
authors.forename: Jordi
authors.initials: J
authors.lastname: Bruix
authors.affiliation: Sección de Hepatología, Servicio de Aparato Digestivo, Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Asturias, España. Electronic address: maria.varelac@sespa.es.
authors.forename: María
authors.initials: M
authors.lastname: Varela
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D055088:Early Detection of Cancer; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011446:Prospective Studies; D013030:Spain
keywords: Carcinoma hepatocelular; Cribado; Hepatocellular carcinoma; Incidence; Incidencia; Screening; Tratamiento; Treatment